[Cholesterol determination in ambulatory general practice within the scope of the Brugg/AG quality circle].
Findings of studies designated by the acronyms 45, WOSCOP, LIPID and CARE have provided data that led physicians to rethink their "cholesterol testing behavior." Twelve physicians participated in a study conducted in cooperation with the quality circle of the Brugg region in Aargau. Each doctor collected data from the files of 100 patients and filled in a questionnaire. Cardiovascular risk factors and arteriosclerotic secondary illnesses were compiled along with demographic data. Moreover, information was gathered on whether the patient's cholesterol levels had been checked within the last five years. In total, 1183 questionnaires were evaluated, comprising 691 women and 492 men with an average age of 48.6 years. Cholesterol levels had been determined within the last five years in 61.2%. The individual testing behavior of the physicians varied. One-third tested all three blood lipid values (total cholesterol, HDL and triglyzerides) with an equivalent frequency. By contrast, one-third primarily only determined total cholesterol. The last one-third mostly tested total cholesterol and triglyzeride levels. The frequency of serum lipid tests increased proportionally to the number of risk factors. Cholesterol levels were tested less frequently (approx. 55%) in smokers and patients who never practiced sports than in patients with other risk factors (approx. 85%). The testing rate increased proportionally to the increasing number of arteriosclerotic secondary illnesses, but did not reach the one-hundred percent mark until 3 secondary illnesses were involved. Dietary counseling was the primary therapeutic intervention; medication was prescribed with a much rarer frequency. Although 75% of the patients with arteriosclerotic secondary illnesses had measurably higher cholesterol levels (> 5.2 mm/l), approx. one-third of the patients with coronary heart disease received therapy with cholesterol-lowering drugs as compared to only 16% of the patients with peripheral occlusive arterial disease. The conclusions that we can draw from these results for clinical practice are: if cholesterol levels are to be determined in order to evaluate a patient's cardiovascular risk, HDL cholesterol levels should also be tested since the ratio of these two values is a good predictor. To date, triglyzeride levels have not been identified as relevant risk factors for vascular events. Physicians evaluated the other risk factors variably, in particular with regard to obesity. For clinical practice, the potential risk factor of lack of exercise should be defined more accurately. In patients with clinically manifest arteriosclerotic secondary illnesses, serum lipids should be tested routinely and appropriate therapy induced when required.
Ledergerber
P P
PP
Departement für Innere Medizin, Medizinische Poliklinik, Universitätsspital Zürich. leder.pema@pop.agri.ch
Steurer
J
J
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D005194:Family Practice; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008332:Management Quality Circles; D008875:Middle Aged; D013557:Switzerland; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D014280:Triglycerides; D002784:Cholesterol