PREVALENCE OF HYPERCHOLESTEROLEMIA AMONG SIBLINGS OF PERSONS WITH PREMATURE CORONARY HEART-DISEASE - APPLICATION OF THE 2ND ADULT TREATMENTPANEL GUIDELINES

Background: Increased blood cholesterol, specifically high low-density lipoprotein cholesterol, increases risk for coronary heart disease (C HD). Persons with a positive family history of premature CHD also are at markedly increased risk. Objective: To examine the prevalence of hy percholesterolemia based on the second report of the National Choleste rol Educational Program Adult Treatment Panel (ATP II) guidelines in t he asymptomatic healthy siblings of people with premature CHD. Methods : A total of 668 asymptomatic healthy siblings (354 men and 314 women) underwent screening for risk factors for CHD. Siblings were categoriz ed into treatment categories for primary prevention defined by ATP II. The percentage who were candidates for intervention were compared wit h the published national estimates for those without CHD from the thir d National Health and Nutrition Examination Survey (NHANES III). Resul ts: Based on ATP II guidelines, 65% of the asymptomatic adult siblings required fasting lipoprotein analysis compared with 33% of adults wit hout CHD in the national reference population. Of the siblings who met the criteria for fasting lipoprotein analysis, most (56%) were candid ates for dietary therapy, more than twice the proportion of adults fro m NHANES III. The percentage of the siblings who qualified for drug in tervention and dietary therapy was 3 times greater than the national s ample, 33% vs 11%, respectively. Assuming a 10% hypothetical reduction in low-density lipoprotein cholesterol levels as the result of dietar y modification, the proportion of the sibling sample who were possible candidates for drug therapy was 20%, still 4 times that predicted for the national sample. Conclusions: These results underscore the need f or aggressive detection and treatment of hypercholesterolemia in this easily identifiable high-risk population of siblings of people with pr emature CHD.