Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey

doi:10.1136/bmj.321.7272.1322

BMJ 2000;321:1322-1325 ( 25 November )

General Practice

Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey

Editorial by Monkman

Paola Primatesta, clinical lecturer, ^a Neil R Poulter, professor. ^b

^a Department of Epidemiology and Public Health, Royal Free and University College Medical School, London WC1E 6BT, ^b Cardiovascular Studies Unit, Department of Clinical Pharmacology, Imperial College School of Medicine, London W2 1PG

Correspondence to: P Primatesta paolap{at}public-health.ucl.ac.uk

Objective: To evaluate the prevalence of the use of lipidlowering agents and its relation to blood lipid concentrationsin Englishadults.
Design: Cross sectionalsurvey.
Setting: England,1998.
Participants: Nationally representative sample of 13 586adults (aged $>=$ 16 years) living in non-institutionalhouseholds.
Main outcome measures: Mean blood concentrations of total cholesteroland high density lipoprotein (HDL) cholesterol, and the ratioof total cholesterol to HDL cholesterol, in participants classifiedby age and sex; prevalence of raised total cholesterol concentrationsand increased ratio of total to HDL cholesterol; prevalence ofuse of lipid lowering agents and the lipid concentrations of peopletakingthem.
Results: Mean total cholesterol concentrations were5.47 (SE 0.02) mmol/l in men and 5.59 (0.02) mmol/l in women.Mean HDL cholesterol concentrations were 1.28 (0.01) mmol/l inmen and 1.55 (0.01) mmol/l in women. Overall, of 10 569 adultswho had a valid cholesterol measurement taken 7133 (67.5%; 95%confidence interval 66.5% to 68.4%) had a total cholesterol concentration $>=$ 5 mmol/l, 2804 (26.5%; 25.7% to 27.4%) had a ratio of total cholesterolto HDL cholesterol $>=$ 5 mmol/l, and 237 (2.2%; 1.9% to 2.5%) reportedtaking lipid lowering drugs. Of 117 participants with no historyof cardiovascular disease but whose estimated 10 year risk ofcoronary heart disease was $>=$ 30% and whose total cholesterol concentrationwas $>=$ 5 mmol/l, four (3%) were taking lipid lowering drugs. Of385 adults aged 16-75 with a history of coronary heart diseaseand eligible for lipid lowering treatment, 114 (30%; 25% to 34%)were taking lipid lowering drugs, of whom only 50 (44%; 35% to53%) had a total cholesterol concentration <5 mmol/l.
Conclusions: Despite the high prevalence of dyslipidaemiain English adults, the proportion of adults taking lipid loweringdrugs in 1998 was only 2.2%. Rates of treatment were low amonghigh risk patients eligible for primary prevention with lipidlowering drugs, and less than one third of patients with establishedcardiovascular disease received suchtreatment.

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