Many doctors not frustrated that patients can't lower cholesterol, despite cardiovascular risks

Jul 17 2007

Family doctors don't always feel that they can achieve healthy cholesterol levels in their patients even though they are aware of the dangers of cardiovascular disease, according to an international survey of practitioners published in the July issue of IJCP, the International Journal of Clinical Practice.

Researchers from the University of Birmingham, UK, and Lund University, Sweden, surveyed 750 doctors from 10 countries – Belgium, Brazil, Denmark, Finland, France, Mexico, Portugal, Singapore, South Korea and the UK - during their From the Heart study.

Doctors told them that only 47% of their patients reached their cholesterol goals, but 61% of them felt this was an acceptable statistic.

“Although doctors appear to appreciate the risks associated with cardiovascular disease – which they identified as a greater cause of death than cancer - the importance of lowering cholesterol does not appear to be widely endorsed” says co-author Professor Richard Hobbs from the University of Birmingham.

“Our study also highlighted discrepancies between what family doctors do when a patient has high cholesterol and what they are advised to do by national guidelines.”

Key findings included:

• Doctors in South Korea (80%) were most likely to be happy with the 47% patient success rate statistic, while doctors in Finland were least happy (48%).
• Prescribing statins (cholesterol lowering drugs) and recommending lifestyle changes was the most popular overall course of action, recommended by 46% of doctors. This was followed by lifestyle changes alone (43%) and statin therapy alone (10%). Only 1.5% recommended no course of action.
• Doctors in South Korea (66%) and Portugal (61.5%) were most likely to recommend a combination of statins and lifestyle changes, with doctors in Finland (31%) and France (36%) least likely to adopt this approach.
• Lifestyle changes alone were most likely to be recommended by doctors in Finland (62%) and France and Denmark (both 50%), with doctors in South Korea (23%) and Portugal (29%) least likely to recommend these.
• Statins alone were most likely to be prescribed by doctors in Brazil (15%) and the UK, France and Mexico (all 11%) and least likely by doctors in South Korea (2.5 %) and Denmark (6%).
• Doctors in South Korea (9%) and France (2%) were most likely to recommend no course of action and doctors in Brazil (0%) and Portugal and Singapore (both 0.3%) least likely.
• The percentage of doctors using national, European or local guidelines to set cholesterol lowering goals averaged 81% and was highest in South Korea (100%) and Brazil (93%) and lowest in the UK (45%) and Singapore (52%).
• The number of family doctors interviewed in each country were: France (100), Mexico (100), Brazil (100), UK (100), Belgium (60), Denmark (60), Finland (60), Portugal (60) and Singapore (60). 50 South Korean specialists were interviewed as they are responsible for writing prescriptions for statins.

“Six out of ten doctors (61%) said they didn’t feel frustrated when they were unable to lower cholesterol in patients with cardiovascular disease, despite the fact that research has shown that lowering cholesterol significantly reduces ill health and death due to cardiovascular disease” concludes co-author Professor Leif Erhardt from Lund University, Sweden.

“Despite the existence of well-defined guidelines and the proven benefits of lowering cholesterol levels, many patients with cardiovascular disease are being under treated and a large proportion fail to achieve cholesterol lowering goals.”

The survey also revealed valuable information on what patients tell doctors when it comes to cholesterol and cardiovascular disease.

Doctors reported that patients feared cancer more than cardiovascular disease and that they were much more likely to see smoking and obesity as high risk factors for cardiovascular disease than high cholesterol.

Country by country statistics

Satisfaction:

• Percentage of doctors satisfied with patients’ 47% success rate: All countries (61%), South Korea (80%), Singapore (77%), Brazil (67%), UK (64%), Denmark (60%), Mexico (59%), Portugal (55%), Belgium (53%), France (49%), Finland (48%).

Doctors’ preferred approach:

• Lifestyle changes and statins (cholesterol lowering drugs): All countries (46%), South Korea (66%), Portugal (61.5%), Singapore (60%), Belgium (47%), UK (47%), Brazil (45%), Denmark (43%), Mexico (41%), France (36%), Finland (31%).
• Lifestyle changes only: All countries (43%), Finland (62%), France (50%), Denmark (50%), Mexico (47%), Belgium (44.5%), UK (41%), Brazil (40%), Singapore (32%), Portugal (29%) South Korea (23%).
• Statins (cholesterol lowering drugs) only: All countries (10%), Brazil (15%), France (11%) UK (11%) Mexico (11%), Portugal (10%), Singapore (8%), Belgium (7%), Finland (7%), Denmark (6%), South Korea (2.5%).
• Neither: All countries (1.5%), South Korea (8.6%), France (2.3%), Belgium (2%), Mexico (1.4%), Denmark (0.8%), Finland (0.8%), UK (0.8%), Portugal (0.3%), Singapore (0.3%), Brazil (0%).

Guidelines:

• Percentage of doctors using national, European or local guidelines to set cholesterol lowering goals: All countries (81%), South Korea (100%), Brazil (93%), Finland (92%), Portugal (88%), Belgium (74%), Denmark (60%), Mexico (60%), France (53%), Singapore (52%) UK (45%).

Figures have been rounded up or down as appropriate.