The next generation: poor compliance with risk factor guidelines in the children of parents with premature coronary heart disease.

OBJECTIVES: The offspring of individuals with premature coronary heart disease are themselves at increased risk for myocardial infarction before the age of 55. Consensus panels have recommended that all such offspring undergo an evaluation of cardiovascular risk, including cholesterol testing. METHODS: To examine self-reported rates of cardiovascular risk factor assessment in this population, we conducted a telephone survey of 318 Canadian adults with premature coronary heart disease and of one offspring from 298 (94%) of the 318 families. RESULTS: The median age of the offspring was 20 years (range 2 to 39 y). Among the 219 late adolescent and young adult offspring, only 97 (44%) reported having had a blood cholesterol measurement during the preceding 3 years. Thirty-seven percent reported being current smokers, 31% were overweight, and 30% exercised fewer than three times per week. Men were less likely than women to report having had their blood pressure measured in the preceding year (57% vs 80%). CONCLUSION: These low rates of cardiac risk factor assessment families of patients with premature coronary heart disease represent missed opportunities for primary prevention. More effective strategies to prevent atherosclerosis in this population are needed.

Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.