Patients Fail To Grasp Importance of Cholesterol Numbers

PAWTUCKET, R.I., May 30 ? Patients may not be getting the message about the heart risks associated with dyslipidemia when the message is delivered by-the-numbers, according to researchers here.

A better way to drive home the message is to concentrate on cardiovascular risk-adjusted age-a formula that homes in on the grim fact that, as an example, a 42-year-old man with elevated Framingham Heart Score has the heart of a 70-year-old man, Brown researchers reported in the May-June issue of Annals of Family Medicine.

That finding emerged from a series of focus groups conducted by Roberta E. Goldman, Ph.D., and colleagues of Brown's department of family medicine and the Center for Primary Care and Prevention at Memorial Hospital of Rhode Island.

The seven focus groups compared three strategies for communicating cardiovascular disease risk related to hypercholesterolemia. Between January and March 2003, the researchers recruited 50 adult patients from primary care practices and through newspaper advertisements in seven New England communities. The patients were paid for participation in each two-hour session.

All participants knew that high cholesterol could adversely affect health, but most did not know their own cholesterol numbers. Moreover, many participants assumed that cholesterol was only a problem for overweight or elderly individuals. Additionally, while participants were familiar with the terms "good" and "bad" cholesterol, few associated those terms with HDL or LDL.

The participants were presented three visual displays that depicted the coronary heart disease risk for a 42-year-old man with a Framingham Heart Score that indicated a 25% risk of cardiovascular disease developing over 10-years.

One visual showed a crowd chart with 100 stick figures. Twenty-five figures were shaded to represent the proportion expected to have a cardiovascular event during the next 10 years. A second chart represented a 42-year-old man with no known risk factors, i.e. a 0.01 probability illustrated with just a single figure shaded.

The second visual illustrated risk with a bar graph in which the 25% risk was a full column versus an apparently empty column to illustrate the man with no risk factors.

Finally, they were shown a horizontal bar chart title HeartAge. The chart had two bars representing age 0 to 76 years. The first bar showed the man's chronological age (42). The second bar illustrated his heart age (70).

HeartAge is calculated by a formula that includes chronologic age, gender, cholesterol and systolic blood pressure numbers, family history of heart disease and smoking history.

"Throughout the focus groups, participants claimed that cholesterol numbers were not an effective means to understand their risk for CVD and indicated that they did not personally relate to the abstractions that cholesterol numbers represented," the authors wrote. "None of the participants recognized the [National Cholesterol Education Program] slogan 'Know your cholesterol numbers, know your risk,' and none found it compelling."

By comparison, the HeartAge illustration was "assessed by almost all participants as engaging and memorable. Reactions included 'it's catchy', 'it grabs you', 'it's an eye-opener', 'it's a wake-up call', and 'it raises your consciousness'."

But a few participants said the HeartAge message might be a bit too real for some patients and predicted that some "might become alarmed if their calculated risk of heart attack or dying of heart disease is similar to that of an older person."

To limit that fear mongering the authors recommend that HeartAge data be accompanied by "clear messages regarding how individuals can work with their physicians to reduce their cardiovascular disease risk."