Screening and treatment of hypercholesterolemia for prevention of coronary heart disease

Undertreatment of hypercholesterolemia for secondary prevention of coronary heart disease has been widely documented. Less is known about screening and treatment for primary prevention. To evaluate recent trends, the rates of low-density lipoprotein (LDL) cholesterol screening and treatment for primary and secondary prevention of coronary heart disease in 1999 and 2003 were quantified from the National Disease and Therapeutic Index and compared. Data were used to examine LDL level reporting, rates at which target levels were attained, and drug therapy among National Cholesterol and Education Panel (NCEP) risk groups. The rate of LDL level reporting increased with greater NCEP risk, ranging from 6% to 7% for visits without risk factors to 31% to 42% for secondary prevention. Rates of meeting LDL targets decreased with greater NCEP risk, ranging from 87% to 88% for visits without risk factors to 29% to 43% for secondary prevention. Drug therapy recommendation also decreased with greater NCEP risk. Despite improvements, underscreening and undertreatment of hypercholesterolemia persists in outpatient visits.