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Fact Sheets and At–a–Glance Reports
State Heart Disease and Stroke Prevention Programs Address High Blood
Cholesterol
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Examples of High Blood Cholesterol Activities in CDC–funded State Heart Disease
and Stroke Prevention Programs Missouri
The Missouri Program along with the Missouri Primary Care
Association (MPCA) developed and distributed physician and nurse
practitioner pocket cards designed to promote use of national
hypertension and cholesterol guidelines. Approximately 2,500 cards were
distributed to clinics and doctor’s offices around Missouri. A survey of
health care providers was conducted to determine the value of this
resource. It was found that Federally Qualified Health Centers were more
likely to find the cards of value (the majority of respondents) and use
them to follow guidelines. Also, the MPCA had several centers report
that they were using the pocket cards to help them develop standing
orders for cholesterol, blood pressure, and A1c level tests for diabetic
patients.
Montana
In 2006, Montana's Cardiovascular Health Program conducted a 20-week
paid media campaign in Flathead County to increase residents' awareness
of the importance of cholesterol control. The Take Control campaign
included television, print, and radio ads. To reinforce the campaign
messages, the program created a Take Control brochure, which was
distributed throughout the community to organizations such as physician
offices, assisted living facilities, and pharmacies. The two local
hospitals assisted with earned media efforts. In conjunction with the
campaign, the program conducted a lipid assessment with a primary care
office in Kalispell. |
High blood cholesterol is a major modifiable risk factor for heart
disease, the leading cause of death in the United States.1 A
10% decrease in total blood cholesterol levels can reduce the incidence of
heart disease by as much as 30%.2
Cost is an important issue when referring to heart disease and stroke. In
2007, the American Heart Association estimates that the direct and indirect
costs for cardiovascular disease will be $431.8 billion.3 This
estimate includes costs of more than $151.6 billion annually for coronary heart
disease. Workplaces are greatly affected with indirect costs that are
estimated to top $148.6 billion in 2007, with those indirect costs relating to
lost productivity. Thus, reducing LDL (bad) cholesterol can be cost
effective in three ways: direct economic savings from decreased hospital and
ambulatory services, preventing coronary heart disease mortality, and
preventing the disability, distress, and pain associated with coronary
heart disease.4
Two of the national health objectives for the year 2010 are to reduce to
17% the percentage of adults aged 20 years or older with total blood
cholesterol levels of greater or equal to 240 mg/dL or higher, which is considered high risk; and to increase to 80% the percentage of adults who had their blood
cholesterol checked during the preceding 5 years.5
An overall national health goal is to eliminate racial/ethnic and other
disparities in all health outcomes, including high blood cholesterol.5
The proportion of American adults aged 20 years and older having high blood cholesterol
levels of 240 mg/dL or higher decreased from 20.8% during 1988–1994
to 16.7% during 2001–2004.6 This decrease is likely due to
the increased use of cholesterol-lowering medications.6 Despite this improvement, from
1991–2003, there was an increase in the proportion of United States participants aged
20 years and older who reported having been told that their blood cholesterol was
high.7 Furthermore, from 1999–2000, more than 50% (107 million) of
adult Americans, particularly women, had blood cholesterol levels of 200 mg/dL or
higher, which is above desirable levels (see table 1).8
During 1991–2003, the percentage of adults in the United States screened
within 5 years increased from 67.5% to 73.1%.7 Only a few states
(Washington, D.C. and Massachusetts) had achieved the Healthy People 2010
objective of 80% prevalence. Most important, there are racial and
ethnic differences in cholesterol screening and awareness. In 2003,
Hispanics and Asians/Pacific Islanders, and younger adults (20–44 years),
had the lowest prevalence of cholesterol screening, 65.5%, 69.6%, and 59.8%,
respectively.7 Although the prevalence of cholesterol screening
during 1991–2003 was higher among women than men, twice as many men as
women were told they had high blood cholesterol.7
Efforts to increase the number of effective public health campaigns, and access to affordable
treatment are needed to raise awareness and increase screening and control
of high blood cholesterol, especially among women, Hispanics, Asian/Pacific
Islanders, and younger adults. Lowering high blood cholesterol can reduce the risk for
developing or dying from heart disease, including heart attacks; however,
less than half of persons who qualify for any kind of lipid treatment for
risk reduction are receiving it.4
Blood cholesterol levels can be lowered through dietary changes, increased
physical activity, weight control, drug therapy, or a combination of these.4
The National Cholesterol Education Program (NCEP) recommends that adults aged 20
years and older have their blood cholesterol levels measured at least once every 5 years.4
A lipoprotein profile is performed to measure different components of total cholesterol
as well as triglycerides (another type of fatty substance that increases risk
for heart disease). See NCEP guidelines for treatment recommendations.
State Heart Disease and Stroke Prevention Programs Take Action
State Health Departments work to prevent and control high blood
cholesterol and reduce the burden of heart disease and stroke by promoting
activities that can be implemented in health care, work sites,
communities, and schools. For example, a state program might—
- Promote policy development, training, and system changes (e.g.,
electronic medical records, automated prescription systems, and paper or
electronic reminders) to assist health care practitioners to adhere to
treatment protocols consistent with national guidelines for
preventing and controlling high blood cholesterol.
- Partner with organizations to assure that detection and follow–up services are available for
controlling high cholesterol in various settings, including health care,
work site, and community.
- Promote the use of clinical care teams that include health
educators to assure consistent screening, detection, risk–factor
education, medication monitoring, and follow–up to prevent and control
high blood cholesterol.
- Educate the public using simple and frequent messages that high
blood cholesterol is a major modifiable risk factor for heart disease
and stroke, and that having one's blood cholesterol checked is an important
first step in identifying and controlling high blood cholesterol and
reducing the risk of heart disease and stroke.
- Collaborate on professional medical education, self–care workshops, policy interventions,
and incentives to improve detection and control of high blood cholesterol.
- Encourage health care insurance coverage for blood cholesterol screening,
treatment, and control, as well as rehabilitation services for heart attack and
stroke survivors.
- Partner with other agencies to establish organizational policies and
environmental interventions that support healthy lifestyles including
access to screening, low–cost healthy food choices, smoke–free
facilities, stress management options, and places for physical activity.
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Table 1. ATP* III Classification of LDL, HDL, Total Cholesterol
and Triglycerides (milligrams/deciliter [mg/dL])†
LDL (Bad) Cholesterol |
Less than 100 |
Optimal |
100–129 |
Near optimal/above optimal |
130–159 |
Borderline high |
160–189 |
High |
190 and above |
Very high |
HDL (Good) Cholesterol |
Less than 40 |
Low |
60 and above |
High (Protective against heart disease) |
Total Cholesterol |
Less than 200 |
Desirable |
200–239 |
Borderline high |
240 and above |
High |
Triglycerides |
Less than 150 |
Desirable |
150–199 |
Borderline high |
200–499 |
High |
500 and above |
Very high |
*ATP = Adult Treatment Panel
† Note: From the Third Report of the National Cholesterol Education
Program (NCEP) on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III), by the National
Heart, Lung, and Blood Institute of the National Institutes of Health, May
2001, pg. 3.
References:
- U.S. Department of Health and Human Services. A
Public Health Action Plan to Prevent Heart Disease and Stroke.
Atlanta, GA: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention; 2003.
- Cohen JD. A Population-based approach to cholesterol control. Am
J Med 1997;102:23–5.
- American Heart Association. Heart Disease and Stroke Statistics:
2007 Update. Dallas (TX): American Heart Association; 2007.
- National Cholesterol Education Program Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive
summary of the third report of the National Cholesterol Education
Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of
High Blood Cholesterol in Adults (ATP III). Circulation 2002;106:3143–3421.
- US Department of Health and Human Services. Healthy People 2010
(conference ed., 2 vols.). Washington, DC: US Department of Health and
Human Services; 2000.
- National Center for Health Statistics. Health, United States,
2006 with Chartbook on Trends in the Health of Americans.
Hyattsville, MD: US Department of Health and Human Services, CDC; 2006.
- CDC. Trends in cholesterol screening and awareness of high blood
cholesterol—United States, 1991–2003, MMWR
2005;54(35):865–870.
- Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum total cholesterol
concentrations and awareness, treatment, and control of
hypercholesterolemia among U.S. adults: Findings from the National
Health and Nutrition Examination Survey, 1999 to 2000. Circulation
2003;107:2185–9.
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Date last reviewed:
03/29/2007
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion |
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