Lipid levels and the use of lipid-lowering agents in England and Scotland

Abstract

Objective

Preventing cardiovascular events with lipid-lowering drugs has been established in several trials reported since 1994. Consequently national guidelines recommend statins for those with established cardiovascular disease (CVD) and those at high risk of developing CVD. We evaluated blood lipid levels, and compare treatment and control of dyslipidaemia in English and Scottish adults with national recommendations for lipid lowering.

Design and methods

In 1998 the nationally-representative Health Survey for England and the Scottish Health Survey included valid cholesterol results for 9631 (England) and 6065 (Scotland) adults aged 16–74. Mean blood levels of total, high-density lipoproteins (HDL-), and total: HDL-cholesterol ratio; prevalence of elevated total cholesterol levels, and total: HDL-cholesterol ratios; prevalence of use of lipid-lowering agents in high risk subgroups; and lipid levels of those on treatment were calculated.

Results

Levels of dyslipidaemia, treatment and control were not significantly different between Scotland and England. Combining these data, mean total cholesterol levels were 5.43 and 5.48mmol/l in men and women respectively; and mean HDL-cholesterol levels were 1.29 and 1.56 mmol/l. Overall 64.6% of adults had a total cholesterol ≥ 5 mmol/l, 24.6% had a total: HDL ratio ≥ 5 and 2.3% reported taking lipid-lowering drugs. Treatment rates among those with a total cholesterol > 5 mmol/l and a history of coronary heart disease or stroke, hypertension, or diabetes, were 27.3%, 15.4% and 17.8% respectively, and control rates (total cholesterol < 5 mmol/l) among those treated were 45.3%, 38.5% and 32.7%. Conclusions Low treatment rates with lipid-lowering drugs existed overall, among high-risk patients suitable for primary prevention, and among those with established cardiovascular disease.