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Cholesterol Screening and Control
Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for cholesterol screening and control, and links to examples and resources.
Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of cholesterol screening and control programs.
Cholesterol is a waxy, fat-like substance found in the body and needed for normal body function. When there is too much cholesterol in the body it is deposited in the arteries including those around the heart which can lead to narrowing of the arteries and to heart disease. High blood cholesterol is one of the major risk factors for heart disease. In adults, total cholesterol levels of 240 mg/dL or higher are considered high risk. Levels from 200 to 239 mg/dL are considered borderline-high risk.
- Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease
- People with heart disease and certain additional diseases, such as type 1 or type 2 diabetes or high blood pressure, have an even greater risk of heart attack
- An estimated 98.6 million adults (about 45.1% of the adult population) in the United States have total blood cholesterol values of 200 mg/dL and higher, and of these about 34.4 million American adults (about 15.7% of the adult population) have levels of 240 or above1
- In 2010, the economic costs of cardiovascular diseases and stroke were estimated at $444.2 billion, including $272.5 billion in direct medical expenses and $171.7 billion in indirect costs6
The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of the High Blood Cholesterol in Adults (Adult Treatment Panel III) recommends cholesterol screening every five years for adults 20 years or older.2-3
The United States Preventive Services Task Force recommends:
- Clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk of coronary heart disease
- Clinicians routinely screen younger adults (men aged 20 to 35 years and women aged 20 to 45 years) for lipid disorders if they have other risk factors for coronary heart disease
- Screening for lipid disorders include measurement of total cholesterol (i.e., total cholesterol) and high-density lipoprotein cholesterol (i.e., HDL cholesterol)
In Rankings of Preventable Services for the U.S. Population, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, cholesterol screening for men aged 35 years and older and women aged 45 years and older received a ranking of 7 on a scale of 1-10, with 10 the highest ranking. Cholesterol screening for men less than 35 years of age and women less than 45 years of age received a ranking of 2.
The best screening tests use blood from a person who has fasted for at least 12 hours and include total lipoprotein (i.e., total cholesterol), low-density lipoprotein (i.e., LDL cholesterol), high-density lipoprotein (i.e., HDL cholesterol). Of these, LDL cholesterol levels are the key predictors of future disease.
LDL cholesterol levels can be reduced with lifestyle changes in obesity, physical activity, and nutrition. Changes in tobacco use and blood pressure further reduce the risk of heart disease. Clinical assessment of each individual can determine whether medication is also necessary to lower cholesterol levels. When someone already has heart disease, medication is usually necessary.
Health-related programs for cholesterol screening and control4
Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.
Employee health surveys in the workplace provide assessment and implementation opportunities
- Information from employee health surveys can be used to identify the percent of employees that have received cholesterol screening. Survey information can be used not only in obtaining baseline group data on employee health but also to educate individual employees to their needs for counseling and follow-up for specific health concerns
- Other surveys can be used as planning guides to assess if a worksite has provided services, programs, policies, and environmental interventions to support healthy lifestyles and prevent risk factors such as high blood cholesterol
Worksite cholesterol screening, health education, and lifestyle counseling can identify employees with high blood cholesterol and help them control it
- Periodic blood cholesterol screening and health risk assessment programs at the worksite through occupational health clinics, health fairs, and other activities can provide blood cholesterol information to employees. Employees who have elevated values should get therapeutic lifestyle counseling and be referred to clinical care for follow-up. Health care professionals or human resources staff can provide information about the benefits and availability of screening to encourage and motivate employees to be screened
- One-on-one education and lifestyle counseling with clinical referral and follow-up should be provided for employees who were determined to have high blood cholesterol. A lifestyle management program is an ongoing series of services designed to teach and counsel participants how to make healthy choices, such as exercise, diet, and tobacco cessation
- Lifestyle counseling, either provided at the worksite or covered through employee health insurance plans, can be provided by health care or allied health professionals (i.e., health educators) or by lay health advisors or volunteers, This type of counseling provides employees with information by telephone or face-to-face in an office or clinic settings or at a workplace
- Screening and lifestyle counseling can be supplemented by brochures, informational letters, videos, newsletters, health fairs, or reminders. The interventions can be tailored to address risks of developing high blood cholesterol, questions, or barriers relevant to the individual or to a group
- Seminars, educational workshops, or classes (including online, telephone conference or self study guide) on preventing and controlling high blood cholesterol can be provided
Worksite lifestyle programs can help employees control their cholesterol
- The health-related program strategies and interventions listed for physical activity, nutrition, obesity, and tobacco use include lifestyle activities recommended to control cholesterol
- Education campaign to educate employees to seek cholesterol screening can be added to workplace nutrition programs
Tools and Resources (more)
- Cholesterol Fact Sheet developed by the Centers for Disease Control and Prevention (CDC)
- High Blood Cholesterol - What You Need to Know publications for consumers and the general public developed by National Heart, Lung, and Blood Institute
- Facts About High Blood Cholesterol fact sheet developed by the National Heart, Lung, and Blood Institute
- Your Guide to Lowering Cholesterol with Therapeutic Lifestyle Changes (TLC) consumer booklet developed by the National Heart, Lung, and Blood Institute
- The American Heart Association has developed a consumer website for Understanding and Controlling Cholesterol
Health-related policies for cholesterol screening and control4
Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”
Policies that enhance worksite lifestyle programs can help employees control their cholesterol
- The health-related policy strategies and interventions listed for physical activity, nutrition, obesity, and tobacco use include lifestyle activities recommended to control cholesterol
Health benefits for cholesterol screening and control3-5
Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.
Provide coverage for cholesterol screening, counseling, and treatment for employees
- Cholesterol screening allows employees and clinicians to identify high cholesterol and begin cholesterol lowering treatments. Reducing total and LDL cholesterol levels to a normal level reduces the risk of heart disease
- The National Cholesterol Education Program’s (NCEP) Adult Treatment Expert Panel-III recommends:
- Clinicians routinely screen all adults aged 20 and older for elevated blood cholesterol levels every 5 years
- Screening should involve a complete lipoprotein profile
- Clinicians counsel all patients at risk for cardiovascular disease (i.e., those individuals with elevated low-density lipoprotein or lower high-density lipoprotein cholesterol levels) about healthy lifestyles, healthy eating (e.g., lowering saturated fat intake), losing weight, and increasing physical activity
- If high blood cholesterol is detected, coverage for the following will enhance clinical care:
- Counseling to promote therapeutic lifestyle changes
- Office visits to monitor high cholesterol and treatment efforts
- Medications used to treat cholesterol disorders
- Health care or allied health professionals (i.e., health educators), or lay health advisors or volunteers need to educate individuals about the benefits and availability of screening, encourage individuals to be screened, and provide lifestyle counseling for those with elevated cholesterol levels. This type of education and counseling can be provided to individuals by telephone, face-to-face in an office or clinic setting, or at the workplace
- Counseling can be supplemented by brochures, informational letters, or reminders. The interventions can be tailored to address risks, questions, or barriers relevant to the individual or to a group
Tools and Resources (more)
- National Business Group on Health’s A Purchasers’ Guide to Clinical Preventive Services: Moving Science into Coverage [PDF - 13KB] describes recommended health benefits language for employee screening and treatment for elevated cholesterol levels
Environmental support for cholesterol screening and control4
Environmental support provides a worksite physically designed to encourage good health.
Worksite environmental support activities for lifestyle change can be used to control cholesterol among employees
- The health-related environmental support strategies and interventions listed for physical activity, nutrition, obesity, and tobacco use include lifestyle activities recommended to control cholesterol
Tools and Resources5
- Leading by Example: Creating Healthy Communities through Corporate Engagement published in 2011 by the Partnership for Prevention features 19 businesses and business groups who are providing leadership and reaching out to improve the health and wellness of their communities providing many benefits to their organizations.
- Leading by Example: The Value of Worksite Health Promotion to Small- and Medium-sized Employers published in 2011 by the Partnership for Prevention provides best practices and strategies for creating or enhancing a worksite health promotion program as well as worksite health program descriptions from almost 20 small employers
- The Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit developed by CDC provides employers with guidelines and recommendations to reduce costs through investing in cardiovascular health programs including collaborating and establishing partnerships with state health organizations
- Reducing the Risk For Heart Disease and Stroke: a Six-Step Guide for Employers [PDF - 1.2MB] developed by CDC, the Six-Step Guide is designed to show employers how they can reduce costs by investing in worksite health promotion and negotiate with health plans to cover preventive services. It also provides steps and resources on how to get started
- Moving into Action: Promoting Heart-Healthy and Stroke-Free Communities
Employers develop by CDC, the American Heart Association/American Stroke Association,
and the Association of State and Territorial Health Officials provides a
range of actions for employers to promote heart-healthy and stroke-free
communities revolving around four themes:
- Demonstrating leadership
- Implementing policies and incentives to make healthy choices the easy choices
- Promoting coverage for and use of preventive health services; and
- Implementing life-saving improvements in health services and medical response
- CDC’s Division for Heart Disease and Stroke Prevention has developed a case study of policy, environmental, and systems-level interventions for managing high blood pressure and high cholesterol in health care settings
- CDC’s Division for Heart Disease and Stroke Prevention website contains multiple tools and resources, information and data, and links to other websites on heart disease and stroke
- The National Heart, Lung, and Blood Institute National Cholesterol
Education Program website contains a
number of health information documents and clinical practice guidelines for