Determinants of cholesterol screening and treatment patterns. Insights for decision-makers

Adult cholesterol screening and treatment policies by the National Cholesterol Education Program recommend that physicians screen all adults aged > 20 [corrected]. On the other hand, the American College of Physicians recommends that healthy young adult men aged > 35 and premenopausal women aged > 45 not be screened due to concerns about the cost of and health risks associated with overuse of pharmacologic therapy in lieu of lifestyle modification.

The objectives of this study were to determine the type of treatment (lifestyle vs. pharmacologic) that physicians actually prescribe for individuals screened for elevated cholesterol.

Self-report data were derived from the 1989-1990 cross-sectional survey of the Stanford Five-City Project on 1,883 Latino and Anglo men and women aged 20 to 74 years of age. A four-stage sequential design was conducted using multiple stepwise regression analyses with a significance cutpoint of P < .01.

Young adult men and women were significantly less likely to report ever having been screened (OR 1.02; 95% CI 1.07-1.09). Individuals of low socioeconomic status (SES) were also significantly less likely to report ever being screened (OR, 1.12; CI, 1.08-1.16), as were Latino men and women, regardless of age (OR 1.57; CI, 1.14-2.18). There were no significant differences in the pattern of physician care utilization among low SES or Latino individuals during the previous 12-month period. Among those under physician care to lower cholesterol, young adults were more likely to be prescribed lifestyle modification (OR, 0.95; CI, 0.92-0.98).

Our results suggest that although young adults are less likely to be screened, if screened they are more likely to be prescribed lifestyle modification than pharmacologic treatment for elevated cholesterol. The lower prevalence of screening among low SES and Latino individuals suggests the need for policy discussions to reduce these disparities.