Cholesterol Evaluation Measures

Once a company has conducted assessment and planning for cholesterol screening and control programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan. For cholesterol screening and control programs, key areas of evaluation include measures to track improvements in cholesterol screening and control outcomes and organizational changes to support cholesterol screening and control such as:

  • Have the number of employees screened for cholesterol increased over the past year
  • Have the number of employees with high cholesterol who made changes to their lifestyle (e.g., lost weight , quit smoking) following screening and counseling increased over the past year
  • Does the worksite offer on-site screening programs and referrals including lifestyle counseling for those employees with high cholesterol
  • Does the worksite have policies and environmental strategies regarding cholesterol screening and control

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.  

High blood cholesterol is one of the major risk factors for heart disease.

  • 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 costs2

The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of the High Blood Cholesterol in Adults (Adult Treatment Panel III)external icon recommends cholesterol screening every five years for adults 20 years or older.3-4

The United States Preventive Services Task Forceexternal icon 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 addition to cholesterol lowering medications, lifestyle changes related to obesity, physical activity, and nutrition can reduce blood cholesterol levels. Changes in tobacco use and blood pressure further reduce the risk of heart disease.

References

1.  Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21-181.

2.  Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. Mar 1 2011;123(8):933—944. Epub 2011 Jan 24.

3.  U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III): executive summary. NIH Publication No. 01-3670. Bethesda, MD: May 2001.

4.  Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.