The hidden perils of high cholesterol:

The global ‘From the Heart’ survey

Did you know that having high cholesterol increases your risk of heart disease and stroke? Or that some cholesterol is good and some bad? Do you know what your cholesterol level is now, and what it ought to be?

If your answer to these questions is a resounding “no”, you’re not alone. A global survey of people with high cholesterol has uncovered an alarming lack of understanding of the link between cholesterol levels and life-threatening conditions known collectively as ‘cardiovascular disease’.

Among people questioned for the ‘From the Heart’ survey, half didn’t know (or couldn’t remember) their current cholesterol level, two-thirds couldn’t name their cholesterol “goal”, and three-quarters were unaware that having high cholesterol could lead to a heart attack.[1]

In fact, raised cholesterol is the single most common risk factor for cardiovascular disease, according to the British Heart Foundation.[2] Cardiovascular disease is the leading cause of death worldwide, contributing to 17 million deaths each year – that’s more than HIV/AIDS and all types of cancer combined.[3]

A survey of attitudes and perceptions

From the Heart is the first global survey to explore attitudes, behaviors, and perceptions towards cholesterol and cardiovascular disease among patients diagnosed with high cholesterol. In all, 1547 patients and 750 family doctors in 10 countries in Europe, Latin America, and Asia were interviewed for the survey.

All patients had been diagnosed as having high cholesterol, yet half said they were not told or could not remember their cholesterol level. Worryingly, most did not know their cholesterol goal (the level they needed to achieve for optimal heart-health).

In an apparent contradiction, however, 99% of doctors said they routinely inform patients of their cholesterol level, and most claimed that they do give patients a specific goal. Only 48% of patients achieved their target cholesterol level.

The discrepancy indicates a need for better communication between doctor and patient, say the survey’s authors. “Doctors must be committed to effectively educating patients about the implications of having high cholesterol and the importance of getting to goal,” says Professor Leif Erhardt, from the University of Malmö in Sweden. “It is essential that people at risk of CVD know what their cholesterol level is, what it should be, and how best to reduce or maintain it.”

Another “silent killer”

There are various explanations for the lack of cholesterol awareness revealed in the From the Heart survey. High cholesterol does not necessarily cause symptoms, and even people with very high cholesterol levels may look and feel well.

Similar to high blood pressure, which is often called the “silent killer”, high cholesterol levels are easily ignored. Yet in the meantime, fatty deposits known as atherosclerosis can build up in the blood vessels, eventually leading to cardiovascular disease including heart disease, heart attack, and stroke.

Communication is key

The link between cholesterol and cardiovascular disease has been the subject of public health campaigns in recent years, along with advice on how a healthy lifestyle can help reduce cholesterol levels. But the From the Heart survey suggests that the message has not yet reached those who need to hear it most – patients.

Although all patients in the survey had been medically diagnosed with high cholesterol:

Only one in four was able to name “heart attack” as a possible consequence of their condition
Less than half had heard of “good” and “bad” cholesterol
More patients feared cancer (50%) than a heart attack or stroke (29%)
Most were not shocked, angry, or upset when diagnosed with high cholesterol
These surprising findings underline the importance of better communication between doctors and patients. Both sides need to be fully informed of all the treatment options available, and to work together to reduce cholesterol to a healthy level.

Encouragingly, raised cholesterol is one of the easiest cardiovascular risks to control. Some cholesterol-lowering therapies, such as more modern statin medications, have been shown to cut bad cholesterol in half, to raise good cholesterol, and to reduce overall cholesterol levels to a healthy target in more than eight out of ten people.[4,5]

Know your number

Cholesterol levels are measured using a simple blood test. Your doctor can tell you whether you should have the test, and what the results mean.

The current European guidelines for total and LDL (“bad) cholesterol are summarized in the table below.[6]  If you do have high cholesterol, knowing your cholesterol goal and following medical advice to achieve it will help reduce your risk of CVD. A number of practical strategies for reaching your target can be found here.

European guidelines for healthy cholesterol levels:[6]

References

1. Adelphi Market Research. From the Heart Survey. AstraZeneca Data on File, 2005.

2. British Heart Foundation. What part does cholesterol play in coronary heart disease ? Accessed 29th June 2006.

3. World Health Organization. Cardiovascular disease: Prevention and control. http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/
Accessed 29th June 2006.

4. Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). American Journal of Cardiology 2003;92:152–60.

5. Schuster H, Barter PJ, Stender S, et al. Effects of switching statins on achievement of lipid goals: measuring effective reductions in cholesterol using rosuvastatin therapy (MERCURY I) study. American Heart Journal 2004;147:705–12.

6. de Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2003;24:1601–10.