Cholesterol

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 for cholesterol include the public health evidence-base 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 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 Taskexternal 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 Rankings of Preventable Services for the U.S. Populationexternal icon , 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.

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.