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.