title: Compliance with National Cholesterol Education Program dietary and lifestyle guidelines among older women with self-reported hypercholesterolemia. The Women's Health Initiative.
abstract: OBJECTIVE
  Dietary therapy remains the first line of treatment for patients with high blood cholesterol levels. Among free-living persons, compliance with National Cholesterol Education Program (NCEP) dietary recommendations is uncertain.
  
  
  METHODS
  We performed a cross-sectional, baseline analysis of 91,627 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Among women with self-reported hypercholesterolemia, we ascertained factors associated with compliance with National Cholesterol Education Program dietary recommendations, defined for the Step II diet as <or=30% of total calories from fat, <7% of calories from saturated fat, and daily dietary cholesterol <200 mg.
  
  
  RESULTS
  Of the 13,777 participants who reported having high cholesterol levels requiring drug therapy, only 20% reported total fat, saturated fat, and dietary cholesterol consumption consistent with Step II dietary goals. Factors associated with Step II dietary compliance included having a college degree (odds ratio [OR] = 1.26; 95% confidence interval [CI]: 1.14 to 1.40), a prior cardiovascular event (OR = 1.48; 95% CI: 1.28 to 1.70), and consumption of five or more daily servings of fruits or vegetables (OR = 3.0; 95% CI: 2.7 to 3.3). Being married, smoking, a sedentary lifestyle, and a higher body mass index were all associated with reduced compliance (all P <0.0001). In the subsample in which plasma lipid levels were measured, dietary compliance was associated with higher levels of low-density lipoprotein cholesterol (P = 0.02).
  
  
  CONCLUSIONS
  Since the inception of the NCEP in 1985, health care providers, public health programs, and patients have not successfully implemented the dietary recommendations.
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA. jhsia@mfa.gwu.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Hsia
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rodabough
authors.forename: Milagros C
authors.initials: MC
authors.lastname: Rosal
authors.forename: Barbara
authors.initials: B
authors.lastname: Cochrane
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Linda
authors.initials: L
authors.lastname: Snetselaar
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008019:Life Style; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000592:standards* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States