Improving lipid profiles and increasing use of lipid-lowering therapy in England: results from a national cross-sectional survey-2006

Objective To evaluate blood lipid levels in the adult English population in 2006 and to report change in the use and efficacy of lipid-lowering treatment since 2003 after which time the general practitioner contract introduced a 'pay-per-performance' approach. Design Cross-sectional surveys. Participants Nationally representative sample of 14 142 noninstitutionalized adults (>16 years) living in England, partaking in the Health Survey for England 2006. Measurements Mean levels of total, HDL, non-HDL and total/HDL cholesterol ratio, prevalence of hypercholesterolaemia, use of lipid lowering agents and lipid levels and control rates among those on treatment. Results Age-standardized mean cholesterol levels fell from 5.49 mm in men and 5.56 mm in women in 2003 to 5.26 and 5.37 mm, respectively, in 2006. In 2006, 59% of adults had a total cholesterol >= 5.0 mm and 11% reported lipid-lowering treatment, of whom 66% had a total cholesterol <5.0 mm and 22% were <4.0 mm. The majority of those with established coronary heart disease, stroke or diabetes but fewer than one quarter of those with hypertension or 20% estimated 10-year cardiovascular risk and no established CVD took lipid-lowering drugs. Lipid lowering treatment rates increased fivefold and control rates among the treated (to <5.0 mm) more than doubled between 1998 and 2006. About one-third of those with established CVD or diabetes had cholesterol levels of <4.0 mm. Conclusions Previously reported improvements in treatment and control rates between 1998 and 2003 continued between 2003 and 2006, with the biggest increases among those with established CVD and diabetes.