Effectiveness and hazards of case finding for a high cholesterol concentration

Abstract

Objective - To see whether adults with high blood cholesterol concentrations (> 6.5 mmol/l) detected by case finding return to their doctor, receive appropriate advice, and report changes in their diet and whether adults found not to have high cholesterol concentrations on case finding are discouraged from changing their diet. Design - Follow up study. Setting - Seven general practices in the lower Hunter region of Australia. Participants - 600 Men and women aged 25-65 who had their blood cholesterol concentrations measured three to four months earlier while attending their general practitioner. Analysis conducted on 552 (92%) who returned follow up postal questionnaires. Measurements and main results - Of the 125 subjects found to have blood cholesterol concentrations greater than 6.5 mmol/l, 102 (82%) returned to their doctor and 83 of these recalled receiving dietary advice. 93 (75%) Subjects with high concentrations reported changing their diet compared with 72 (46%) subjects with concentrations of > 5.5-6.5 mmol/l and 44 (17%) subjects with lower concentrations. Overall 333 (61%) of all respondents who answered reported not changing their diet, the most common reason (nearly half the sample; n = 266) being that their cholesterol concentration was 'all right'. Adults without high cholesterol concentrations who returned to their doctor saying that they did not need to lower their concentrations (≤ 5.5 mmol/l = 61%; > 5.5-6.5 mmol/l = 12%; > 6.5 mmol/l = 5%) and significantly less likely to recall receiving dietary advice (≤ 5.5 mmol/l = 13%; > 5.5-6.5 mmol/l = 60%; > 6.5 mmol/l = 82%). Conclusions - High risk strategies which require everyone to be tested for high cholesterol concentrations may interfere with population strategies designed to reduce everyone's dietary intake of fat.