Levels of dyslipidaemia and improvement in its management in England: results from the Health Survey for England 2003

Objective To evaluate blood lipid levels in the adult English population and to report changes in the use and efficacy of lipid-lowering treatment between 1998 and 2003. Design Cross-sectional surveys. Participants Nationally representative sample of 8269 non-institutionalized adults (>= 16 years) living in England, taking part in the Health Survey for England 2003. Measurements Mean levels of total, HDL, non-HDL and total : HDL cholesterol ratio; prevalence of hypercholesterolaemia; use of lipid-lowering agents and lipid levels among those on treatment; blood pressure. Information on smoking and history of cardiovascular events and diabetes were recorded by the interviewer. Results In 2003 69.9% of adults had a total cholesterol >= 5 mmol/l and 6.2% reported lipid-lowering treatment. Treatment rates among those with a total cholesterol >= 5 mmol/l and a history of coronary heart disease or stroke, hypertension or diabetes were 71.1%, 32.7% and 50.9%, respectively in men; and 55.8%, 22.4% and 50.0% in women. In all these groups, more than half of those treated were controlled (< 5 mmol/). Only small changes in levels of dyslipidaemia were seen since 1998 (when 67.5% of adults had a total cholesterol >= 5 mmol/l), but use of lipid-lowering treatment has more than doubled and control rates have increased by approximately fourfold. Conclusions Treatment and control rates of lipids have improved importantly between 1998 and 2003 but remain suboptimal. Reductions in major cardiovascular events are likely to result from these changes and may be further enhanced by adherence to the new general practitioner contract.