Americans undergo cholesterol testing, but most fail to remember results Baltimore average is third-highest

August 27, 1993|By Jonathan Bor | Jonathan Bor,Staff Writer

Americans may know enough about cholesterol to take a simple blood test, but not enough to remember much about it later on.

The majority of adults contacted in a national survey said they had heeded warnings about heart disease and had their cholesterol checked -- but more than half drew a blank when asked for the results.

The findings come eight years into a high-profile federal campaign aimed at convincing Americans to reduce their heart attack risk by checking their cholesterol and taking steps to reduce it if the level is high.

"We've said cholesterol is important and people are going out and getting their cholesterol checked," said Dr. Robert Vogel, chairman of cardiology at the University of Maryland Medical Center. "But frankly, they're not paying much attention to the results."

The emerging picture, he said, is of a nation where cholesterol is becoming a household word, even though many people lack the knowledge to understand what the level means.

Although not part of the group sponsoring the survey, Dr. Vogel said he was concerned by findings that pertained specifically to Baltimore. Here, total cholesterol among people who knew the figure averaged 215 milligrams per deciliter of blood -- the third highest average for a city.

St. Louis had the highest average level, 220, while Albuquerque, N.M. was lowest at 188. A level below 200 is considered desirable.

The survey of 5,000 adults in 25 cities was commissioned by a nonprofit group called Citizens for Public Action on Blood Pressure and Cholesterol. The group, composed mainly of cardiologists, is part of a coalition helping to coordinate the National Cholesterol Education Program, launched in 1985 by the federal government. Merck & Co., which makes a cholesterol-lowering drug, paid for the study.

The poll targeted men over 45 and women over 55 -- ages at which the risk of developing symptoms of heart disease begins to rise steeply.

Nationally, almost 90 percent of those polled said they had had their cholesterol checked in recent years. In Denver, half of those who had their cholesterol checked could remember the figure -- the best response in any of the cities. Baltimore ranked second, at 48 percent, and Atlanta was lowest at 31 percent.

Cholesterol is a fatty material that can collect along the walls of arteries and, in some cases, trigger a heart attack or stroke by obstructing the flow of blood. People with elevated levels are often advised to eat a low-fat diet, exercise and -- in some cases -- to take cholesterol-lowering drugs.

Dr. Peter Kwiterovich, who directs the lipids clinic at the Johns Hopkins Hospital, said there were many reasons why Americans may be paying scant attention to their cholesterol -- including confusing labels on packaged food, insufficient consumer education in the schools and poor nutritional training in the medical schools.

"Medical school is focused on taking the person who is very sick and making them better very quickly," said Dr. Kwiterovich, who is a member of the group that commissioned the survey. "We could prevent a lot of people from becoming very sick by practicing good preventive medicine."

Also, he said, many doctors simply tell patients that their levels are high or low without specifying the test results. But he said people should know their levels just as they know their weight or blood pressure so they can track their progress and become active participants in their health management.

Dr. Vogel said a survey begun in 1991 at the University of Maryland found that three-quarters of people admitted to the hospital with high cholesterol and symptoms of heart disease had not been receiving any treatment to lower their cholesterol.

Although physicians could find plenty of discouraging news in the surveys, the coordinator of the federal program said substantial progress has been made in recent years.

Dr. James I. Cleeman of the National Heart, Lung and Blood Institute said the average cholesterol level among adults dropped from 213 to 205 between 1978 and 1990. Meanwhile, the percentage of people with desirable cholesterol rose from 44 percent to 49 percent.

"By any measure, cholesterol levels have come down," Dr. Cleeman said. "There are lots of factors. Certainly, dietary change has been on of them." Deaths due to coronary heart disease have also dropped steadily, but lower rates of smoking and hypertension were also major factors in the decline.

Total cholesterol is considered a place to start when assessing the risk for heart disease, but not necessarily an indication of risk by itself.

In June, the National Cholesterol Education Report said cholesterol-lowering treatments ought to be targeted toward people with high cholesterol and a history of chest pains, heart attack or bypass surgery.

People with high cholesterol and no history of heart disease are nonetheless considered at risk if they have other complicating factors such as diabetes or a family history of heart disease.

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