Wang J S, Carson E C, Lapane K L, Eaton C B, Gans K M, Lasater T M
Brown University, School of Medicine, Providence, Rhode Island 02912, USA.
Prev Med. 1999 Mar;28(3):221-8. doi: 10.1006/pmed.1998.0454.
Elevated serum cholesterol is a major risk factor for CHD. Primary prevention through behavioral modification has been designated first-line treatment for patients with elevated cholesterol. In this study, we assessed the impact of a physician office visit after a worksite cholesterol screening on self-reported changes in diet, weight loss, exercise, and smoking. We hypothesized that those individuals who had a physician office visit regarding cholesterol would make more changes in CHD risk factors than those who did not have such a visit.
A cohort of 4,928 participants from 33 work-sites in Massachusetts and Rhode Island had baseline CHD risk factors evaluated at a cholesterol screening and 4,473 were available at follow-up 6 months later by telephone interview. A total of 1,957 had elevated cholesterol levels (>/=200 mg;/dl) and were instructed to visit their physician, in addition to receiving educational materials related to CHD risk factor modification.
Most individuals with elevated cholesterol levels had other prevalent self-reported CHD risk factors at baseline: 58% consumed high-fat diets (>30% fat), 43% were overweight, 60% had a sedentary lifestyle (sweat-related physical activity <3 x per week), and 22% were cigarette smokers. After 6 months of follow-up, 74% of participants with high-fat diets reported eating a lower fat diet, 71% of overweight participants reported weight loss, 53% of sedentary participants attempted to increase physical activity, and 38% of smokers decreased or quit cigarette smoking. Thirty-five percent of participants completed the referral for a physician office visit to discuss their elevated cholesterol determined at the baseline worksite screening. However, these individuals showed only a modest change (which was not statistically significant) in self-reported CHD risk factors compared with those who did not have follow-up physician visits after adjusting for age, sex, race, education, occupation, medical insurance, time since last doctor visit, diabetes, and hypertension. Objective measurements of serum cholesterol, body mass index, and dietary score were likewise modestly improved and not statistically significant.
In 6 months of follow-up, high absolute levels of CHD risk factor modification were observed after a worksite cholesterol screening. A physician office visit added only a modest but not statistically significant benefit for further CHD risk factor modification. These findings indicate that the follow-up cholesterol-related physician visit had little added clinical benefit over the screening intervention alone.
血清胆固醇升高是冠心病的主要危险因素。通过行为改变进行一级预防已被指定为胆固醇升高患者的一线治疗方法。在本研究中，我们评估了工作场所胆固醇筛查后医生门诊对自我报告的饮食、体重减轻、运动和吸烟变化的影响。我们假设，那些就胆固醇问题进行医生门诊的个体在冠心病危险因素方面的改变会比未进行此类门诊的个体更多。
来自马萨诸塞州和罗德岛州33个工作场所的4928名参与者组成的队列在胆固醇筛查时对冠心病危险因素进行了基线评估，6个月后通过电话访谈对4473名参与者进行了随访。共有1957人的胆固醇水平升高（≥200mg/dl），除了收到与冠心病危险因素改变相关的教育材料外，还被指示去看医生。
大多数胆固醇水平升高的个体在基线时还有其他普遍自我报告的冠心病危险因素：58%的人食用高脂肪饮食（脂肪含量>30%），43%的人超重，60%的人有久坐不动的生活方式（与出汗相关的体力活动每周<3次），22%的人吸烟。随访6个月后，74%食用高脂肪饮食的参与者报告饮食脂肪含量降低，71%超重的参与者报告体重减轻，53%久坐不动的参与者试图增加体力活动，38%的吸烟者减少或戒烟。35%的参与者完成了转介去医生门诊，以讨论他们在基线工作场所筛查中确定的胆固醇升高问题。然而，在调整年龄、性别、种族、教育程度、职业、医疗保险、上次看医生后的时间、糖尿病和高血压后，与未进行后续医生门诊的个体相比，这些个体在自我报告的冠心病危险因素方面仅出现了适度变化（无统计学意义）。血清胆固醇、体重指数和饮食评分的客观测量同样有适度改善，但无统计学意义。
在6个月的随访中，工作场所胆固醇筛查后观察到冠心病危险因素有较高的绝对改变水平。医生门诊对进一步改变冠心病危险因素仅增加了适度但无统计学意义的益处。这些发现表明，与仅进行筛查干预相比，后续与胆固醇相关的医生门诊几乎没有额外的临床益处。
