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Public cholesterol screening in the previously diagnosed: misuse of resources or beneficial function?
L A Maiman1, P Greenland, N G Hildreth
1Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, NY.
Insights
Public cholesterol screenings benefit individuals with prior hyperlipidemia diagnoses. Follow-up care after screening significantly lowers blood cholesterol levels in diagnosed participants.
Area of Science:
- Public Health
- Cardiovascular Disease Prevention
- Health Screening Programs
Background:
- Public cholesterol screenings are sometimes criticized for including individuals with pre-existing hyperlipidemia.
- This study addresses the value of cholesterol screenings for participants with a prior diagnosis of high cholesterol.
- Understanding post-screening actions and physician responses is crucial for evaluating program effectiveness.
Purpose of the Study:
- To explore the post-screening actions of participants with a previous hyperlipidemia diagnosis.
- To assess the impact of medical follow-up on cholesterol levels and health behaviors.
- To determine if including previously diagnosed individuals in screenings has merit.
Main Methods:
- Surveyed 811 participants with prior hyperlipidemia diagnoses attending a public cholesterol screening.
- Tracked medical follow-up actions, physician interventions (retesting, advice, prescriptions), and self-reported behaviors.
- Compared outcomes between participants who sought medical care and those who did not, analyzing cholesterol levels one year post-screening.
Main Results:
- 74% of participants sought medical follow-up within five months.
- Physicians increased dietary advice and medication prescriptions; high-risk individuals received more attention.
- Follow-up care led to improved dietary practices, increased regimen compliance, and a significant 4.5% reduction in cholesterol levels after one year.
Conclusions:
- Public cholesterol screenings appear beneficial for individuals with a prior hyperlipidemia diagnosis.
- Confirmation of high cholesterol levels and subsequent medical referral positively impacts patient outcomes.
- Including previously diagnosed individuals in screening programs may be a valuable public health strategy.
Abstract:
The attendance of individuals with a previous diagnosis of hyperlipidemia at public cholesterol screenings is often criticized as a misuse of such programs. This study explored the post-screening actions of 811 participants in a cholesterol screening program who had previously been diagnosed with cholesterol elevations and whose blood levels at this screening required further medical referral. We also studied the responses of physicians from whom these subjects sought care. Within five months, 559 of 753 participants completing the survey (74.0%) sought medical follow-up. Physicians retested the blood cholesterol levels of 75.0% of these 559; high-risk screenees were more likely to be retested and to be informed that their levels were elevated than moderate-risk subjects (P < .0001). Physicians increased cholesterol-lowering dietary advice for high-risk subjects (P < .0001) and medication prescriptions for both risk groups (P < .0001). Participants seeking medical care after the screening program had better cholesterol-lowering dietary practices and reported increased regimen compliance (moderate-risk: P = .01; high-risk: P < .0001) than those individuals not obtaining medical follow-up. One year after screening, blood cholesterol levels were 4.5% lower (P = .001) in those complying with referral but were virtually unchanged in noncompliers. Screening program confirmation of high blood cholesterol levels combined with referral appeared to have a positive impact on previously diagnosed screenees. We conclude that there may be merit in including previously diagnosed individuals in cholesterol screening programs.