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Updated: Aug 15, 2026
Cholesterol Efflux Assay
Published on: March 6, 2012
Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) guidelines
J P Frolkis1, S J Zyzanski, J M Schwartz
1Lipid Research Center, PHS Mount Sinai Medical Center, Cleveland, Ohio, USA.
Insights
Physician adherence to National Cholesterol Education Program (NCEP-ATPII) guidelines for cardiovascular risk screening and hyperlipidemia treatment is low. Even high-risk patients often do not receive recommended screening or treatment.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Assessing physician adherence to clinical practice guidelines is crucial for improving patient outcomes.
- The National Cholesterol Education Program (NCEP-ATPII) provides guidelines for cardiovascular risk factor screening and hyperlipidemia management.
- Understanding current physician practices is essential for identifying gaps in care.
Purpose of the Study:
- To evaluate the frequency of physician adherence to NCEP-ATPII guidelines.
- To determine rates of cardiovascular risk factor screening and hyperlipidemia treatment by physicians.
- To identify areas of non-compliance with NCEP guidelines.
Main Methods:
- Retrospective review of 225 randomly sampled patient charts from a coronary care unit (January-June 1996).
- Outcome measures included screening rates for various cardiovascular risk factors, counseling rates (smoking cessation, diet, exercise), and adherence to NCEP algorithms for lipid management.
- Data analysis focused on comparing physician practices against NCEP criteria.
Main Results:
- Screening rates varied significantly by risk factor, with lower rates for diabetes (37%) and hormone therapy (11%).
- Counseling rates were notably low: 4% for smoking cessation, 14% for dietitian referral, and 1% for exercise encouragement.
- Lipid-lowering treatment was initiated more often when NCEP criteria indicated, but 36% of hospitalized and 46% of discharged patients eligible for treatment remained untreated.
Conclusions:
- Physicians demonstrate poor compliance with NCEP guidelines for risk factor assessment and counseling, even in high-risk cardiovascular patients.
- Adherence to NCEP-ATPII algorithms for LDL cholesterol assessment was only 50%, a critical step in treatment evaluation.
- While NCEP criteria influence treatment decisions, a substantial number of eligible patients do not receive necessary lipid-lowering therapy.
Background:
We sought to determine the frequency with which physicians follow National Cholesterol Education Program (NCEP-ATPII) guidelines in screening for cardiovascular risk factors and treating hyperlipidemia.
Methods And Results:
We conducted a retrospective chart review on randomly sampled charts of 225 patients admitted to the coronary care unit between January and June 1996. The main outcome measures were rates of physician screening for coronary heart disease risk factors; rates of counseling for cigarette cessation, diet, and exercise; and extent of use of NCEP algorithms for obtaining LDL cholesterol values and treating hypercholesterolemia. Screening rates for interns (who performed best) were: cigarette use (89%), known coronary heart disease (74%), hypertension (68%), hyperlipidemia (59%), family history (56%), diabetes (37%), postmenopausal hormone therapy (11%), and premature menopause (1%). Four percent of smokers were counseled to quit, 14% of patients were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indicated on the basis of NCEP criteria. Patients were more likely to receive lipid-lowering treatment if NCEP criteria indicated that they should, but 36% of hospitalized patients and 46% of patients who should have been treated on discharge were not.
Conclusions:
Physicians are poorly compliant with NCEP guidelines for risk factor assessment and counseling, even in patients at high risk for coronary heart disease. Physicians follow NCEP-ATPII algorithms for obtaining an LDL value, a key step in evaluating the need for treatment, only 50% of the time. NCEP criteria seem to influence the decision to initiate lipid-lowering therapy, but significant numbers of eligible patients remain untreated.
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