Management of high blood cholesterol levels in Nova Scotian adults: Comparison with the NCEP II and European Clinical Practice Guidelines

Objective: To compare the prevalence of dietary and drug treatment for high blood cholesterol levels with indication for treatment according to the National Cholesterol Education Program (NCEP) II and European clinical practice guidelines. Study design: A population-based, cross-sectional study. Patients and methods: Data were from the 1995 Nova Scotia Health Survey. Patients were 2078 respondents aged 20 to 74 years who provided blood samples. Based on cardiovascular risk factors, respondents were compared with guidelines to determine eligibility for dietary and antilipemic drug therapy. Results: According to the NCEP II and European guidelines, 21% and 13%, respectively, of the population were estimated to be dietary therapy candidates and 12% and 4%, respectively, were estimated to be candidates for antilipemic drug therapy. Less than half of the dietary therapy candidates, according to either guidelines, reported being diagnosed, and only about half of those diagnosed reported having received dietary therapy. Overall, 6% to 15% of the NCEP II drug therapy candidates and 12% to 37% of the European drug therapy candidates were estimated to be receiving antilipemic drugs. Only about 45% of the NCEP II and 60% of the European drug therapy candidates reported being diagnosed as having high blood cholesterol levels, and only about 50% of the NCEP II- and 60% of the European-diagnosed drug therapy candidates reported having received dietary therapy. The estimated prevalence of antilipemic drug therapy among diagnosed drug therapy candidates was 12% to 29% for the NCEP II and 12% to 52% for the European guidelines. Conclusions: Dietary therapy and antilipemic drug therapy were underused relative to the NCEP II and European guidelines as a result of underdiagnosis and low use of treatment after diagnosis. Large differences in the recommendations of the 2 guidelines, however, show lack of consensus as to who should be treated and point to the need for additional research on this issue.