Spotlight: Cholesterol Education & Awareness
Cholesterol is a naturally occurring, wax-like substance produced by the liver, and it plays an important role in everything from hormone function to vitamin D absorption. Cholesterol is carried throughout the body via the bloodstream, and is comprised of low-density lipoproteins (LDL, or "bad" cholesterol) and high-density lipoproteins (HDL, or "good" cholesterol). Having healthy levels of both HDL and LDL cholesterol is important; however, an increased level of LDL cholesterol is a leading risk factor for certain types of heart disease. Effective management of elevated LDL cholesterol is an important part of heart disease prevention.
According to the Centers for Disease Control and Prevention, one out of six Americans has an elevated LDL cholesterol level, and many Veterans have higher risk factors for heart disease—including elevated LDL levels. To help improve the health of Veterans, investigators with the VA Health Services Research & Development (VA HSR&D) service conduct studies that contribute to the body of knowledge surrounding cholesterol management guidelines, pharmacological interventions, and treatment effectiveness. The following two examples are recent VA HSR&D studies that have addressed different aspects of cholesterol treatment:
Examining How Risk for Heart Disease is Classified
National cholesterol guidelines are used to classify patients into different risk groups for heart disease and to guide treatment decisions. Risk classification and treatment decisions are important because about 36 million people in the U.S. are eligible for lipid-lowering medication. This study compared risk estimates and classification differences in the predicted 10-year risk of heart disease between using the original risk classification model, called the "Framingham model," to a simpler version of the same model. Results of the study show that compared with the original model, the simpler version misclassifies millions of Americans into different risk groups, with substantial potential impacts on drug treatment recommendations for cholesterol control. Read more.
Comparing Strategies for Therapy to Lower Cholesterol
Statin medications for the control of cholesterol are one of the most effective treatments in medicine, yet controversy remains about their use. For example, although treating to lipid targets (called "Treat-to-Target") is widely recommended for preventing coronary artery disease, some advocate giving fixed doses of statins based on an individual's estimated benefit from that specific dose (called "Tailored Treatment"). This study, funded through VA/HSR&D's Quality Enhancement Research Initiative (QUERI), compared a simple Tailored Treatment strategy with a Treat-to-Target strategy based on National Cholesterol Education Program treatment guidelines. Study results show that the Tailored Treatment strategy for statin therapy was more efficient and prevented substantially more illness and death related to coronary artery disease than any of the currently recommended Treat-to-Target approaches. Read more.
To learn more about cholesterol management, and about how VA HSR&D researchers are contributing to the understanding of cholesterol management, use the links in the Resources box, to the right.