Attitude changes of general practitioners towards lowering LDL cholesterol

Clinical studies have demonstrated the benefit of lowering cholesterol in decreasing coronary complications. These results need to be implemented in clinical practice, where an important barrier are the attitudes of physicians.

General practitioners in the city of Helsinki were asked to respond to two questionnaires sent to them by post 12 months apart (1996 and 1997); 284 responses were received in 1996 and 258 in 1997.

In addition to brief questions aimed to characterize the responding physician, the questionnaire included four examples of patients: (1) middle-aged man without, or (2) with coronary heart disease (CHD); (3) 70-year-old man with a history of stroke; (4) 70-year-old women with CHD. The physicians were asked at what level of serum low-density-lipoprotein (LDL) cholesterol they usually initiate drug therapy. Comparisons were made longitudinally between 1996 and 1997, as well as between different patients. Analyses are based on the responses of those physicians who reported that they treat atherosclerotic patients (241 and 237 in 1996 and 1997, respectively).

In case 1 (primary prevention), 40.1% of general practitioners in 1996 compared with 52.4% in 1997 (difference +12.3, 95% CI +3.2(-)+20.9, P < 0.01) reported that they would initiate drug therapy at the LDL cholesterol level < 5.0 mmol/l. In case 2 (secondary prevention), 42.0% in 1996 and 54.8 in 1997 (difference +12.8, 95% CI +4.0(-)+21.8, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. In case 3 (70 year man with stroke), 13.8% in 1996 compared with 30.4% in 1997 (difference +16.6, 95% CI +9.4(-)+24.0, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. In case 4 (70 year old woman with CHD) 12.8% in 1996 compared with 34.2% in 1997 (difference +21.4%, 95% CI + 13.9(-)+28.7, P < 0.01) would initiate drug therapy at the LDL cholesterol level < 4.0 mmol/l. The physicians' attitudes were significantly more active towards LDL cholesterol lowering both in 1996 and 1997 in case 2 compared with case 1, case 3 or case 4. No difference was observed between case 3 and case 4.

Between 1996 and 1997 the attitudes of general practitioners towards lowering LDL cholesterol have become significantly more active in all four patient categories. However, the attitudes are still not optimal concerning coronary patients and especially older atherosclerotic patients.