NEW YORK, NY -- September 10, 1997 -- Although physicians believe they have educated their patients thoroughly, patients still say they do not understand the basics about cholesterol and other lipid risk factors, according to surveys of patients with high cholesterol and of physicians who prescribe medications for high cholesterol. The two surveys, sponsored by Kos Pharmaceuticals, Inc., were released today.
Experts speaking at a Dyslipidemia Roundtable sponsored by the Citizens for Public Action on Blood Pressure and Cholesterol, Inc., re-emphasized that physicians' current primary emphasis on reducing total and LDL cholesterol is a critical starting point. However, for many patients, much more is needed.
The expert panel urged physicians to take the time and care to look beyond LDL at the other lipid levels that may factor into their patients' coronary heart disease (CHD) risk. Additionally, they urged patients to get more involved and proactively ask their physicians to explain the levels and the significance of all their lipoproteins in terms they understand.
Although more than half of physicians surveyed report their patients are knowledgeable about the components that comprise the total lipid profile, a majority of high-cholesterol patients said they are unfamiliar with these other lipids that are also indicators for coronary heart disease. In fact, almost half of patients surveyed said their physicians have never discussed with them all of the lipids that factor into total lipid management.
"These survey results clearly indicate that many patients who are at risk are either not receiving or not understanding critical cholesterol information, which could serve to motivate them to lower all of their CHD risk factors," said Gerald Wilson, executive director for Citizens for Public Action on Blood Pressure and Cholesterol, Inc. "The patient survey, in fact, indicated that more than half of the patients surveyed did not know which lipoprotein was good (HDL) and which were bad."
Of the surveyed high-cholesterol patients, only nine percent knew their LDL level, 11 percent knew their HDL level and 12 percent knew their triglyceride level. Despite a majority of physicians saying they spend at least some time discussing HDL and triglycerides with their patients, only six percent of high-cholesterol patients say their doctor has discussed achieving ideal targets for HDL levels and only five percent have been told their triglyceride ideal target levels. Only three percent of the patients surveyed
were familiar with Lp(a), an emerging lipid risk factor associated with CHD.
Maintaining low total cholesterol has traditionally been considered a significant step in decreasing individual risk for CHD. However, many people have multiple lipid disorders. New research highlights the importance of knowing the levels of all lipoproteins. In addition to low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides each play a role in understanding a patient's global coronary risk. Further still, emerging risk factors including Lp(a) and abnormal LDL particle size (even
when total LDL is normal) are the focus of ongoing research.
Coronary heart disease has been firmly linked to increased levels of LDL and decreasing elevated levels of LDL has conclusively been shown to reduce the incidence of heart attack and death. Made up of a family of cholesterol and triglyceride-rich particles, LDL levels when elevated or abnormal in composition can lead to hardening of the arteries and atherosclerosis. Conversely, low levels of HDL -- the body's good cholesterol -- may also increase an individual's risk for disease. The family of HDL particles carry cholesterol in the blood back to the liver, leading to its removal from the body.
Dr. Peter Kwiterovich, Director of the Lipid Research-Atherosclerosis Unit, Johns Hopkins University Hospital and a panelist for the roundtable discussion, highlighted the growing importance of knowing a patient's HDL levels in assessing the risk of CHD.
Recent studies illuminate the significance of lipoprotein abnormalities beyond LDL cholesterol in managing the risk of cardiovascular disease. Citing research published in major medical journals, panelists discussed the link between elevated levels of both triglycerides and Lp(a), abnormal LDL particle
size and the prevalence of heart disease. A study, for example, in the American Journal of Cardiology concluded high triglyceride levels were shown to more than double a person's risk for heart disease. According to a recent European study, women with elevated Lp(a) levels were almost three times as likely to suffer a heart attack.
"As we continue to learn more about HDL, triglycerides, and Lp(a), it is abundantly clear that measurement of total cholesterol is no longer enough to determine heart disease risk," said Antonio Gotto, MD, PhD, Stephen and Suzanne Weiss Dean and Professor of Medicine at Cornell University Medical
College and roundtable speaker. "Awareness of LDL, HDL, and triglyceride levels is critical in assessing appropriate therapeutic options. What works for one individual will not necessarily work for the next."
The survey involved 200 primary care physicians who prescribe medications for high cholesterol and 500 patients diagnosed with total cholesterol levels above 200.
