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Detection and treatment of hypercholesterolemia in a biethnic community, 1979-1985
J A Pugh1, M P Stern, S M Haffner
1Department of Medicine, University of Texas Health Science Center at San Antonio.
Insights
Awareness and treatment of high cholesterol were low in both Mexican-Americans and non-Hispanic whites before 1985. This study highlights the need for better hypercholesterolemia management to prevent coronary heart disease (CHD).
Area of Science:
- Cardiovascular epidemiology
- Public health
- Medical history
Background:
- Hypercholesterolemia is a known risk factor for coronary heart disease (CHD).
- Clinical trials demonstrating cholesterol-lowering efficacy for CHD prevention emerged in recent years.
- 1985 NIH consensus conference established guidelines for hypercholesterolemia diagnosis and treatment.
Purpose of the Study:
- To assess awareness and treatment of hypercholesterolemia in Mexican-Americans (MAs) and non-Hispanic whites (NHWs).
- To evaluate the effectiveness of treatment for hypercholesterolemia in these populations prior to 1985.
Main Methods:
- Community-based survey: San Antonio Heart Study (1979-1985).
- Examined 1,932 MAs and 1,133 NHWs.
- Assessed awareness, treatment, and control of high cholesterol levels.
Main Results:
- Low awareness of high cholesterol: 7% of MAs and 17% of NHWs in moderate/high-risk categories.
- Low treatment rates: 24% of aware MAs and 27% of aware NHWs received treatment.
- Limited treatment effectiveness: 39% of treated MAs and 41% of treated NHWs achieved control.
- MAs had lower awareness than NHWs, but both groups showed poor treatment levels.
Conclusions:
- Significant gaps existed in hypercholesterolemia awareness and management among both MAs and NHWs before 1985.
- Ethnic disparities in awareness were observed, with MAs being less aware.
- Urgent need for improved public health strategies and clinical interventions for hypercholesterolemia control to mitigate CHD risk.
Abstract:
Although hypercholesterolemia has been recognized as a risk factor for coronary heart disease (CHD) for decades, only in recent years have clinical trials definitively shown the efficacy of lowering serum cholesterol to prevent the occurrence or worsening of CHD. In 1985, an NIH consensus conference published guidelines for the diagnosis and treatment of hypercholesterolemia. Prior to 1985, physicians and lay people alike were not yet convinced of the necessity to know one's cholesterol level, nor did they know what levels should be treated. In a community-based survey of cardiovascular risk factors, known as the San Antonio Heart Study, in which 1,932 Mexican-Americans (MAs) and 1,133 non-Hispanic whites (NHWs) were examined between 1979 and 1985, the authors found that only 36/501 MAs (7%) and 54/312 NHWs (17%) in the moderate- or high-risk categories were aware that their cholesterols were high. Of the total number aware, including those whose cholesterol levels were in the low-risk range, only 23/97 MAs (24%) and 29/108 NHWs (27%) were receiving dietary or drug treatment. Of those being treated, only 9/23 MAs (39%) and 12/29 NHWs (41%) were effectively controlled. Mexican-Americans were less likely to be aware of their hypercholesterolemia than non-Hispanic whites, but both ethnic groups had low levels of treatment.