Lipid screening and treatment by cardiologists have not improved

Much effort by the national cholesterol education program (NCEP) and others have been made to induce physicians to screen for and treat lipid abnormalities in patients with coronary heart disease. We measured the effect of these efforts in a single group of cardiovascular specialists. We reviewed 20 percent of applicable patient records from 1987, 1989, and 1994 was performed to identify documented screening (cholesterol levels or lipid profiles) and treatment over 12 months after an index admission for coronary heart disease, along with a survey of physician acquaintance with NCEP guidelines, among the eight cardiovascular physicians. In the 160 patients with angina pectoris or myocardial infarction, total cholesterol levels were determined in 77-95 percent and lipid profiles determined in 2-11 percent. Treatment for cholesterol, greater than 150 mg/dl was initiated in 14-32 percent. These rates did not significantly improve over the study period. Yet, all physicians were acquainted with the NCEP and five of the eight perceived their screening and treatment to be more aggressive in 1994 than in 1987. Lipid screening and treatment by cardiovascular specialists have not improved despite copious supportive literature. Barriers other than lack of knowledge may impede implementation of this effective therapy.