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Highlights in Minority Health
September, 2004
 

  Cholesterol Education. September 2004
 
 
SEPTEMBER IS  CHOLESTEROL EDUCATION MONTH
Cholesterol is a waxy, fat-like substance found in your body and is needed for the body to function normally. Your body makes enough cholesterol for its needs. When there is too much cholesterol in your body —because of diet and the rate at which the cholesterol is processed— it is deposited in arteries, including those of the heart, which can lead to narrowing of the arteries and heart disease. Clinical trials have proved that lowering cholesterol in persons with and without existing coronary heart disease (CHD) reduces illness and death from CHD and even reduces overall death rates.
An estimated 105 million American adults have total blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher, which is above desirable levels. Of these, 42 million have levels of 240 mg/dL or higher, which is considered high risk (2002).
Desirable or optimal levels for persons with or without existing heart disease are as follow:
green square Total cholesterol: Less than 200 mg/dL.
green square
 
Low Density Lipoprotein (LDL) cholesterol ("bad" cholesterol): Less than 100 mg/dL.
green square
 
High Density Lipoprotein (HDL) cholesterol ("good" cholesterol): 40 mg/dL or higher.
green square Triglycerides: Less than 150 mg/dL.

Experts recommend that all adults aged 20 years and older have their cholesterol levels checked at least once every five years to help them take action to prevent or lower their risk of CHD. Blood cholesterol levels are influenced by modifiable factors including diet and level of physical activity. Lifestyle changes that prevent or lower high blood cholesterol include eating a diet low in saturated fat and cholesterol, increasing physical activity, and reducing excess weight.  Studies show that a diet low in saturated fat, dietary cholesterol, and total fat —with physical activity and weight control— can lower blood cholesterol levels. Medications are also available to help persons lower and control high blood cholesterol levels.

EXAMPLES OF HEALTH DISPARITIES RELATED TO HIGH BLOOD CHOLESTEROL
 
African Americans
In 2001, the age-adjusted death rate for diseases of the heart for African Americans was 316.9 per 100,000 population. The age-adjusted death rate for diseases of the heart was 247.8 per 100,000 for all Americans, and 245.6 per 100,000 for white non-Hispanic Americans.
In 1999-2000, 17.7% of African American women 20 years and over had high serum cholesterol (240 mg/dL or higher), while 10.6% of African American men had high serum cholesterol (age-adjusted).  During the same period of time, 18.3% of all Americans ages 20 years and over had high serum cholesterol (age-adjusted).
In 2003, the percent of adults who reported ever having their cholesterol checked was lower among African Americans (74.4%) than among whites (80.4%) and lower than the general population (76.9%). The percent of adults who reported having their cholesterol checked in the past five years was lower among African Americans (71.5%) than among whites (75.8%) and slightly lower than the general population (72.9%).
Hispanics/Latinos
In 2001, the age-adjusted death rate for diseases of the heart for Hispanics/Latinos was 192.2 per 100,000 population. The age-adjusted death rate for diseases of the heart was 247.8 per 100,000 for all Americans, and 245.6 per 100,000 for white non-Hispanic Americans.
In 1999-2000, 13.9% of Mexican American* women 20 years and over had high serum cholesterol (240 mg/dL or higher), while 17.8% of Mexican American* men had high serum cholesterol (age-adjusted).  During the same period of time, 18.3% of all Americans ages 20 years and over had high serum cholesterol (age-adjusted).
In 2003, the percent of adults who reported ever having their cholesterol checked was lower among Hispanics/Latinos (66.1%) than among whites (80.4%) and lower than the general population (76.9%). The percent of adults who reported having their cholesterol checked in the past five years was lower among Hispanics/Latinos (62.9%) than among whites (75.8%) and lower than the general population (72.9%).
Asians/Pacific Islanders (APIs)
In 2001, the age-adjusted death rate for diseases of the heart for APIs was 137.6 per 100,000 population. The age-adjusted death rate for diseases of the heart was 247.8 per 100,000 for all Americans, and 245.6 per 100,000 for white non-Hispanic Americans.
In 2000-2001, 60.5% of Asian men and 63.4% of Asian women in selected communities had ever received cholesterol screening.  During the same period of time, 31.4% of Asian men and 23.3% of Asian women had high cholesterol (defined as ever being told by a doctor or other health professional that blood cholesterol was high).
Native Hawaiians disproportionately suffer the burden of heart disease, compared to other ethnic groups in the State of Hawaii.  Heart disease is the leading cause of death among APIs.
American Indians/Alaska Natives (AI/ANs)
In 2001, the age-adjusted death rate for diseases of the heart for AI/ANs was 159.6 per 100,000 population. The age-adjusted death rate for diseases of the heart was 247.8 per 100,000 for all Americans, and 245.6 per 100,000 for white non-Hispanic Americans.
The mean total cholesterol levels of AI/ANs are generally lower or comparable to the levels of other U.S. populations. However, the percent of AI/ANs ages 18 and over who had coronary heart disease in 2001 is the highest of all racial and ethnic groups (8.6% for AIAN only; 12.1% for AIAN and white; 6.3% for total population).
In 2000-2001, 68.5% of AIAN men and 76.0% of AIAN women in selected communities had ever received cholesterol screening.  During the same period of time, 37.1% of AIAN men and 33.5% of AIAN women had high cholesterol (defined as ever being told by a doctor or other health professional that blood cholesterol was high).
PROMISING INTERVENTION STRATEGIES
 
 Cholesterol awareness is a multi-step process that requires
  1.) being screened,
  2.) being told a level, and
  3.) remembering that level
Cholesterol awareness requires success in all three steps combined. Because persons may know their cholesterol levels does not necessarily indicate they will take actions to reduce their cholesterol levels; however, it is an important step in the process of cholesterol reduction. Persons who are aware of their cholesterol levels are more likely to initiate steps to reduce their blood cholesterol levels.
Factors that may be associated with variations in cholesterol screening and awareness by state include differences in
  1.)

 
perceptions (among both health-care providers and the public) about the risk for CHD and about the effectiveness of cholesterol reduction,
  2.) the availability and quality of health care, and
  3.) the socioeconomic resources within communities
Despite the relatively low level of cholesterol awareness, in recent years, substantial progress has been made in increasing cholesterol screening and awareness. For example, previous studies have indicated the proportion of U.S. adults who knew their cholesterol levels increased substantially from 1986 through 1990. Public and private program efforts to increase awareness for both health-care providers and the public have included mass media campaigns, cholesterol screenings, and educational seminars. In addition, to increase identification and treatment of high blood cholesterol, the National Cholesterol Education Program (NCEP) mailed guidelines to approximately 150,000 primary-care physicians in the United States. However, to contribute to further reductions in CHD morbidity and mortality, additional efforts are needed to increase cholesterol screening and awareness among young adults, minorities, and persons with less than a high school education.
 
PROGRAMS
To reduce the prevalence of high blood cholesterol in the United States, the National Heart, Lung, and Blood Institute (NHLBI) initiated the National Cholesterol Education Program (NCEP) in 1985 to encourage all adults to have their cholesterol levels checked at least once every 5 years, know their cholesterol levels, and if it is elevated, take steps to lower their levels. The goal of the NCEP is to contribute to reducing illness and death from CHD in the United States by reducing the percentage of Americans with high blood cholesterol. Through educational efforts directed at health professionals and the public, the NCEP aims to raise awareness and understanding about high blood cholesterol as a risk factor for CHD and the benefits of lowering cholesterol levels as a means of preventing CHD.
Since NCEP was launched, the percentage of persons who have had their cholesterol checked has more than doubled, from 35 percent in 1983 to 75 percent in 1995.  Consumption of saturated fat, total fat, and cholesterol declined during the 1980s and 1990s, average blood cholesterol levels in adults dropped from 213 mg/dL in 1978 to 203 mg/dL in 1991 (age adjusted to 1980 population), and the prevalence of high blood cholesterol requiring medical advice and treatment fell from 36 percent to 29 percent.  These results reflect the impact of NCEP’s population and high-risk strategies for lowering cholesterol.  Average total cholesterol declined from 213 mg/dL in 1976–80 to 203 mg/dL in 1988–94, and the prevalence of high blood cholesterol declined from 26 percent to 19 percent, thereby achieving the year 2000 target.
*Health, US, 2003 table 67 reports Mexican ethnicity in lieu of Hispanic origin.

 

FOR MORE INFORMATION
  National Center for Chronic Disease Prevention and Health Promotion
    A Public Health Action Plan to Prevent Heart Disease and Stroke
    Cardiovascular Health
      Cholesterol Fact Sheet
    Racial and Ethnic Approaches to Community Health (REACH) 2010
  National Heart, Lung, and Blood Institute
    Addressing Cardiovascular Health in Asian Americans and Pacific Islanders
    Building Healthy Hearts for American Indians and Alaska Natives
    Cholesterol
    Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
    The Impact of Heart Disease on Asian Americans and Pacific Islanders
    Information for Selected Audiences
    Latino Community Cardiovascular Disease Prevention and Outreach Initiative
    National Cholesterol Education Program
    Research in Coronary Heart Disease in Blacks
  Federal Citizen Information Center
    So You Have High Blood Cholesterol . . .


 

 

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