Abstract
Background
Although current guidelines emphasize the importance of cholesterol knowledge, little is known about accuracy of this knowledge, factors affecting accuracy, and the relationship of self-reported cholesterol with cardiovascular disease (CVD).
Methods
The 39,876 female health professionals with no prior CVD in the Women’s Health Study were asked to provide self-reported and measured levels of total and high-density lipoprotein (HDL) cholesterol. Demographic and cardiovascular risk factors were considered as determinants of awareness and accuracy. Accuracy was evaluated by the difference between reported and measured cholesterol. In addition, we examined the relationship of self-reported cholesterol with incident CVD over 10 years.
Results
Compared with women who were unaware of their cholesterol levels, aware women (84%) had higher levels of income, education, and exercise and were more likely to be married, normal in weight, treated for hypertension and hypercholesterolemia, nonsmokers, moderate drinkers, and users of hormone therapy. Women underestimated their total cholesterol by 9.7 mg/dL (95% CI: 9.2–10.2); covariates explained little of this difference (R 2 < .01). Higher levels of self-reported cholesterol were strongly associated with increased risk of CVD, which occurred in 741 women (hazard ratio 1.23/40 mg/dL cholesterol, 95% CI: 1.15–1.33). Women with elevated cholesterol who were unaware of their level had particularly increased risk (HR=1.88, P <. 001) relative to aware women with normal measured cholesterol.
Conclusion
Women with obesity, smoking, untreated hypertension, or sedentary lifestyle have decreased awareness of their cholesterol levels. Self-reported cholesterol underestimates measured values, but is strongly related to CVD. Lack of awareness of elevated cholesterol is associated with increased risk of CVD.
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Acknowledgement
This study was supported by grants (HL43851, CA47988) from the National Institutes of Health and by philanthropic support from Elizabeth and Alan Doft and their family. The abstract was presented at the 2nd International Conference on Women, Heart Disease and Stroke, February 16–19, 2005 (Circulation 2005;111: e40–e88).
Conflict of Interest
Dr. Huang has no potential conflicts of interest. Dr. Buring has received investigator-initiated research funding and support from Dow Corning Corporation, research support for pills and/or packaging on NIH-funded studies from Bayer Health Care and the Natural Source Vitamin E Association, honoraria from Bayer for speaking engagements, and she serves on an external scientific advisory committee for a study by Procter & Gamble. Dr. Ridker has received investigator-initiated research support from Astra-Zeneca, Bayer, Bristol-Myers Squibb, Dade-Behring, Novartis, Pharmacia, Roche, Sanofi-Aventis, and Variagenics. Dr. Ridker is listed as a coinventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease and has served as a consultant to Schering-Plough, Sanofi-Aventis, Astra Zeneca, Isis Pharmaceutical, and Dade-Behring. Dr. Glynn has received investigator-initiated research support from Astra-Zeneca, Bristol-Myers Squibb, and Novartis.
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Huang, Py.A., Buring, J.E., Ridker, P.M. et al. Awareness, Accuracy, and Predictive Validity of Self-Reported Cholesterol in Women. J GEN INTERN MED 22, 606–613 (2007). https://doi.org/10.1007/s11606-007-0144-1
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DOI: https://doi.org/10.1007/s11606-007-0144-1