Hypercholesterolemia, eligibility for lipid-lowering therapy and therapeutic success: population-based study in a Portuguese urban population.
BACKGROUND
We aimed to estimate i) the prevalence of hypercholesterolemia, ii) the proportion of individuals eligible for treatment with lipid-lowering drugs, and iii) therapeutic success, according to the European guidelines on cardiovascular disease prevention in clinical practice.


METHODS
Population-based cross-sectional study.


METHODS
We surveyed a representative sample of the population of Porto aged 40-65 years. Trained interviewers collected data from 1215 subjects (789 women) on demographic variables, medical history, and medication using structured questionnaires. A fasting venous blood sample was withdrawn. Subjects were considered low risk or high risk as indicated in the European guidelines. Hypercholesterolemia was defined as total cholesterol (TC) > or = 5 mmol/l or low-density-cholesterol (LDL-C) > or = 3 mmol/l in low-risk subjects, TC > or = 4.5 mmol/l or LDL-C > or = 2.5 mmol/l in high-risk subjects or being medicated with lipid-lowering drugs. Eligibility for treatment was defined as being high risk and having TC > or = 4.5 mmol/l, LDL-C > or = 2.5 mmol/l or being on treatment. We defined therapeutic success as having TC < 4.5 mmol/l and LDL-C < 2.5 mmol/l among medicated subjects.


RESULTS
Overall, 84.9% (95% confidence interval (95% CI): 82.7-86.8) of subjects had hypercholesterolemia and 9.1% (95% CI: 7.5-10.8) were medicated with lipid-lowering drugs. Men were more likely to be eligible for treatment (42.4%) than women (22.4%; OR=2.69, 95% CI 2.07-3.52). Therapeutic success was less frequent in men (46.8%) than in women (66.7%), (OR=0.39, 95% CI 0.17-0.87).


CONCLUSIONS
Strict interpretation of the European guidelines would label 85% of the general population in this age group as hypercholesterolemic and a third eligible for drug treatment. Questions arise regarding medicalization, resource allocation, and sustainability within the healthcare system.
Alves
Luis
L
Department of Hygiene and Epidemiology, University of Porto Medical School, Institute of Public Health, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal. pdsp07011@med.up.pt
Azevedo
Ana
A
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011174:Portugal / Q000453:epidemiology; D012307:Risk Factors; D014505:Urban Population
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL