System Failure: Countries Too Slow to Identify and Treat High Cholesterol

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We know cardiovascular disease is a global killer but the numbers still have the power to shock. Heart and circulatory illnesses claim more than 17 million lives every year, almost half under the age of 60.

What makes these figures more disturbing is that many deaths, and the debilitating conditions that often precede them, which diminish quality of life and put a burden on health care systems, could be avoided by taking steps to reduce high blood pressure, cut smoking and lower cholesterol, so-called “modifiable risk factors” for heart disease. (More on Statins May Not Prevent Heart Disease in Healthy People)

A report just published in the Bulletin of the World Health Organization compares the efforts of eight countries to diagnose and treat elevated cholesterol levels. Surveying data from 147 million people, this is the largest such study yet undertaken and the results are depressing: not only are wealthy countries too slow to prescribe cholesterol-lowering statins but the populations of middle-income countries are becoming increasingly prone to high cholesterol levels, once a “disease of affluence,” as the report’s authors point out.

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle sifted through data from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the U.S.; the data were collected over various time periods, but used comparable measures and methodologies. Researchers discovered that Thailand had the highest proportion of citizens with undiagnosed high cholesterol and the U.S. the lowest, but the overall benefits of diagnosis were undermined by the failure in the U.S. and elsewhere to treat the condition.

Anyone who has sampled Scottish culinary delights such as deep-fried pizza and deep-fried Mars Bars or witnessed the Scots’ culture of binge drinking won’t be surprised to discover that high cholesterol is a problem in that country. But the problem isn’t felt evenly across the population. Scottish women are less likely to be diagnosed or treated than their male counterparts.

Japan has the worst record on prescribing cholesterol-lowering drugs to patients after diagnosis, with 53% left untreated. Germany and the U.S. also perform poorly. “Cholesterol-lowering medication is widely available, highly effective and can play an essential role in reducing cardiovascular disease around the world,” said Dr. Gregory A. Roth, one of the study’s co-authors. “Despite these facts, effective medication coverage for control of high cholesterol remains disappointingly low.” (More on Sudden Cold Fronts Mean More Heart Attacks)

Mexico emerges comparatively well from the report, identifying and managing to control 58% of cases. “Although [this] is encouraging, its cause is unclear,” say the authors. However they are convinced that the improved availability and decreasing costs of statins heralds an opportunity for all countries to do better on tackling cardiovascular disease.

The global study was made public on the same day that the U.S. government issued its own, even cheaper proposals toward that same goal: eat more healthily — and eat less. What will they think of next. Exercise?

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