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Highlights in Minority Health
September, 2004
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SEPTEMBER IS
CHOLESTEROL EDUCATION MONTH |
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Cholesterol is a waxy, fat-like substance found in your body and is
needed for the body to function normally. Your body makes enough
cholesterol for its needs. When there is too much cholesterol in
your body —because of diet and the rate at
which the cholesterol is processed— it is
deposited in arteries, including those of the heart, which can lead
to narrowing of the arteries and heart disease. Clinical trials have
proved that lowering cholesterol in persons with and without
existing coronary heart disease (CHD) reduces illness and death from
CHD and even reduces overall death rates. |
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An estimated 105 million American adults have total blood cholesterol
levels of 200 milligrams per deciliter (mg/dL) and higher, which is
above desirable levels. Of these, 42 million have levels of 240 mg/dL
or higher, which is considered high risk (2002). |
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Desirable or optimal levels for persons with or without existing heart
disease are as follow: |
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Total cholesterol: Less than 200 mg/dL. |
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Low Density Lipoprotein (LDL) cholesterol ("bad" cholesterol): Less
than 100 mg/dL. |
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High Density Lipoprotein (HDL) cholesterol ("good" cholesterol): 40
mg/dL or higher. |
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Triglycerides: Less than 150 mg/dL. |
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Experts recommend that all adults aged 20 years and older have their
cholesterol levels checked at least once every five years to help
them take action to prevent or lower their risk of CHD. Blood
cholesterol levels are influenced by modifiable factors including
diet and level of physical activity. Lifestyle changes that prevent
or lower high blood cholesterol include eating a diet low in
saturated fat and cholesterol, increasing physical activity, and
reducing excess weight. Studies show that a diet low in saturated
fat, dietary cholesterol, and total fat
—with physical activity and weight control— can
lower blood cholesterol levels. Medications are also available to
help persons lower and control high blood cholesterol levels. |
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EXAMPLES
OF HEALTH DISPARITIES RELATED TO HIGH BLOOD CHOLESTEROL |
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African Americans |
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In 2001, the age-adjusted death rate for diseases of the heart for
African Americans was 316.9 per 100,000 population. The age-adjusted
death rate for diseases of the heart was 247.8 per 100,000 for all
Americans, and 245.6 per 100,000 for white non-Hispanic Americans. |
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In 1999-2000, 17.7% of African American women 20 years and over had
high serum cholesterol (240 mg/dL or higher), while 10.6% of African
American men had high serum cholesterol (age-adjusted). During the
same period of time, 18.3% of all Americans ages 20 years and over
had high serum cholesterol (age-adjusted). |
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In 2003, the percent of adults who reported ever having their
cholesterol checked was lower among African Americans (74.4%) than
among whites (80.4%) and lower than the general population (76.9%).
The percent of adults who reported having their cholesterol checked
in the past five years was lower among African Americans (71.5%)
than among whites (75.8%) and slightly lower than the general
population (72.9%). |
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Hispanics/Latinos |
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In 2001, the age-adjusted death rate for diseases of the heart for
Hispanics/Latinos was 192.2 per 100,000 population. The age-adjusted
death rate for diseases of the heart was 247.8 per 100,000 for all
Americans, and 245.6 per 100,000 for white non-Hispanic Americans. |
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In 1999-2000, 13.9% of Mexican American* women 20 years and over had
high serum cholesterol (240 mg/dL or higher), while 17.8% of Mexican
American* men had high serum cholesterol (age-adjusted). During the
same period of time, 18.3% of all Americans ages 20 years and over
had high serum cholesterol (age-adjusted). |
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In 2003, the percent of adults who reported ever having their
cholesterol checked was lower among Hispanics/Latinos (66.1%) than
among whites (80.4%) and lower than the general population (76.9%).
The percent of adults who reported having their cholesterol checked
in the past five years was lower among Hispanics/Latinos (62.9%)
than among whites (75.8%) and lower than the general population
(72.9%). |
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Asians/Pacific Islanders (APIs) |
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In 2001, the age-adjusted death rate for diseases of the heart for
APIs was 137.6 per 100,000 population. The age-adjusted death rate
for diseases of the heart was 247.8 per 100,000 for all Americans,
and 245.6 per 100,000 for white non-Hispanic Americans. |
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In 2000-2001, 60.5% of Asian men and 63.4% of Asian women in
selected communities had ever received cholesterol screening.
During the same period of time, 31.4% of Asian men and 23.3% of
Asian women had high cholesterol (defined as ever being told by a
doctor or other health professional that blood cholesterol was
high). |
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Native Hawaiians disproportionately suffer the burden of heart
disease, compared to other ethnic groups in the State of Hawaii.
Heart disease is the leading cause of death among APIs. |
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American Indians/Alaska Natives (AI/ANs) |
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In 2001, the age-adjusted death rate for diseases of the heart for
AI/ANs was 159.6 per 100,000 population. The age-adjusted death rate
for diseases of the heart was 247.8 per 100,000 for all Americans,
and 245.6 per 100,000 for white non-Hispanic Americans. |
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The mean total cholesterol levels of AI/ANs are generally lower or
comparable to the levels of other U.S. populations. However, the
percent of AI/ANs ages 18 and over who had coronary heart disease in
2001 is the highest of all racial and ethnic groups (8.6% for AIAN
only; 12.1% for AIAN and white; 6.3% for total population). |
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In 2000-2001, 68.5% of AIAN men and 76.0% of AIAN women in selected
communities had ever received cholesterol screening. During the
same period of time, 37.1% of AIAN men and 33.5% of AIAN women had
high cholesterol (defined as ever being told by a doctor or other
health professional that blood cholesterol was high). |
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PROMISING INTERVENTION STRATEGIES |
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Cholesterol awareness is a multi-step
process that requires |
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being screened, |
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being told a level, and |
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remembering that level |
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Cholesterol awareness requires success in all three steps combined.
Because persons may know their cholesterol levels does not
necessarily indicate they will take actions to reduce their
cholesterol levels; however, it is an important step in the process
of cholesterol reduction. Persons who are aware of their cholesterol
levels are more likely to initiate steps to reduce their blood
cholesterol levels. |
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Factors that may be associated with variations in cholesterol
screening and awareness by state include differences in |
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1.)
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perceptions (among both health-care providers and the public) about
the risk for CHD and about the effectiveness of cholesterol
reduction, |
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the availability and quality of health care, and |
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the socioeconomic resources within communities |
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Despite the relatively low level of cholesterol awareness, in recent
years, substantial progress has been made in increasing cholesterol
screening and awareness. For example, previous studies have
indicated the proportion of U.S. adults who knew their cholesterol
levels increased substantially from 1986 through 1990. Public and
private program efforts to increase awareness for both health-care
providers and the public have included mass media campaigns,
cholesterol screenings, and educational seminars. In addition, to
increase identification and treatment of high blood cholesterol, the
National Cholesterol Education Program (NCEP) mailed guidelines to
approximately 150,000 primary-care physicians in the United States.
However, to contribute to further reductions in CHD morbidity and
mortality, additional efforts are needed to increase cholesterol
screening and awareness among young adults, minorities, and persons
with less than a high school education. |
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PROGRAMS |
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To reduce the prevalence of high blood cholesterol in the United
States, the National Heart, Lung, and Blood Institute (NHLBI)
initiated the National Cholesterol Education Program (NCEP) in 1985
to encourage all adults to have their cholesterol levels checked at
least once every 5 years, know their cholesterol levels, and if it
is elevated, take steps to lower their levels. The goal of the NCEP
is to contribute to reducing illness and death from CHD in the
United States by reducing the percentage of Americans with high
blood cholesterol. Through educational efforts directed at health
professionals and the public, the NCEP aims to raise awareness and
understanding about high blood cholesterol as a risk factor for CHD
and the benefits of lowering cholesterol levels as a means of
preventing CHD. |
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Since NCEP was launched, the percentage of persons who have had their
cholesterol checked has more than doubled, from 35 percent in 1983
to 75 percent in 1995. Consumption of saturated fat, total fat, and
cholesterol declined during the 1980s and 1990s, average blood
cholesterol levels in adults dropped from 213 mg/dL in 1978 to 203
mg/dL in 1991 (age adjusted to 1980 population), and the prevalence
of high blood cholesterol requiring medical advice and treatment
fell from 36 percent to 29 percent. These results reflect the
impact of NCEP’s population and high-risk strategies for lowering
cholesterol. Average total cholesterol declined from 213 mg/dL in
1976–80 to 203 mg/dL in 1988–94, and the prevalence of high blood
cholesterol declined from 26 percent to 19 percent, thereby
achieving the year 2000 target. |
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*Health, US, 2003 table 67 reports Mexican ethnicity in lieu of
Hispanic origin. |
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