Skip to main content

Advertisement

SpringerLink
Log in

Awareness, Accuracy, and Predictive Validity of Self-Reported Cholesterol in Women

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  2. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994;89:1333–445.

    Google Scholar 

  3. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office; 2000.

    Google Scholar 

  4. Centers for Disease Control and Prevention. Progress in chronic disease prevention factors related to cholesterol screening and cholesterol level awareness—United States, 1989. MMWR Morb Mortal Wkly Rep. 1990;39:633–7.

    Google Scholar 

  5. Schucker B, Wittes J, Santanello N, et al. Change in cholesterol awareness and action: results from national physician and public surveys. Arch Intern Med. 1991;151:666–73.

    Article  PubMed  CAS  Google Scholar 

  6. Pieper RM, Arnett DK, McGovern PG, Shahar E, Blackburn H, Luepker RV. Trend in cholesterol knowledge and screening and hypercholesterolemia awareness and treatment, 1980–1992: the Minnesota Heart Survey. Arch Intern Med. 1997;157:2326–32.

    Article  PubMed  CAS  Google Scholar 

  7. Nash IS, Mosca L, Blumenthal RS, Davidson MH, Smith SC, Pasternak RC. Contemporary awareness and understanding of cholesterol as a risk factor. Arch Intern Med. 2003;163:1597–1600.

    Article  PubMed  Google Scholar 

  8. Nieto FJ, Alonso J, Chambless L, et al. Population awareness and control of hypertension and hypercholesterolemia. The Atherosclerosis Risk in Communities study. Arch Intern Med. 1995;155:677–84.

    Article  PubMed  CAS  Google Scholar 

  9. Centers for Disease Control and Prevention. State-specific cholesterol screening trends—United States, 1991–1999. MMWR Morb Mortal Wkly Rep. 2000;49:750–5.

    Google Scholar 

  10. Centers for Disease Control and Prevention. Cholesterol screening and awareness—Behavioral Risk Factor Surveillance System, 1990. MMWR Morb Mortal Wkly Rep. 1992;41(36).

  11. Mosca L, Ferris A, Fabunmi R, Robertson RM. Tracking women’s awareness of heart disease—an American Heart Association National Study. Circulation 2004;109:573–9

    Article  PubMed  Google Scholar 

  12. Bowlin SJ, Morrill BD, Nafziger AN, Jenkins PL, Lewis C, Pearson TA. Validity of cardiovascular disease risk factors assess by telephone survey: the Behavioral Risk Factor Study. J Clin Epidemiol. 1993;46:561–71.

    Article  PubMed  CAS  Google Scholar 

  13. Bowlin S, Morrill B, Nafziger A, Lewis C, Pearson T. Reliability and changes in validity of self-reported cardiovascular disease risk factors using dual response: The Behavioral Risk Factor Survey. J Clin Epidemiol. 1996;49:511–7.

    Article  PubMed  CAS  Google Scholar 

  14. Natarajan S, Lipsitz SR, Nietert PJ. Self-report of high cholesterol-determinants of validity in U.S. adults. Am J Prev Med. 2002;23:13–21.

    Article  PubMed  Google Scholar 

  15. Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. 1986;123:894–900.

    PubMed  CAS  Google Scholar 

  16. Newell S, Girgis A, Sanson-Fisher R, Ireland M. Accuracy of patients’ recall of Pap and cholesterol screening. Am J Public Health. 2000;90:1431–5.

    Article  PubMed  CAS  Google Scholar 

  17. Murdoch M, Wilt TJ. Cholesterol awareness after case-finding: do patients really know their cholesterol numbers? Am J Prev Med. 1997;13:284–9.

    PubMed  CAS  Google Scholar 

  18. Bairey Merz CN, Felando MN, Klein J. Cholesterol awareness and treatment in patients with coronary artery disease participating in cardiac rehabilitation. J Cardiopulm Rehabil. 1996;16:117–22.

    Article  PubMed  CAS  Google Scholar 

  19. Rexrode KM, Lee I, Cook NR, Hennekens CH, Buring JE. Baseline characteristics of participants in the Women’s Health Study. J Womens Health Gend Based Med. 2000;9:19–27.

    Article  PubMed  CAS  Google Scholar 

  20. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005;352:1293–304.

    Article  PubMed  CAS  Google Scholar 

  21. Lee IM, Cook NR, Gaziano JM, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer. The Women’s Health Study: a randomized controlled trial. JAMA 2005;294:47–55.

    Article  PubMed  Google Scholar 

  22. Hosmer DW, Lemeshow S. Applied Logistic Regression, 2nd edition. New York: John Wiley and Sons; 2000.

    Google Scholar 

  23. Harawa NT, Morgenstern H, Beck J, Moore A. Correlates of knowledge of one’s blood pressure and cholesterol levels among older members of a managed care plan. Aging. 2001;13:95–104.

    PubMed  CAS  Google Scholar 

  24. Nelson K, Norris K, Mangione CM. Disparities in the diagnosis and pharmacologic treatment of high serum cholesterol by race and ethnicity—data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2002;162:929–35

    Article  PubMed  Google Scholar 

  25. Brennan RM, Crespo CJ, Wactawski-Wende J. Health behaviors and other characteristics of women on hormone therapy: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Menopause 2004;11:536–42.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Division of Preventive Medicine, 900 Commonwealth Avenue, Boston, MA, 02215, USA

    Peng-yun A. Huang MBBS, MPH, Julie E. Buring ScD, Paul M. Ridker MD, MPH & Robert J. Glynn PhD, ScD

  2. Division of Cardiology, Brigham and Women’s Hospital, Boston, MA, USA

    Paul M. Ridker MD, MPH

  3. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Julie E. Buring ScD, Paul M. Ridker MD, MPH & Robert J. Glynn PhD, ScD

  4. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    Robert J. Glynn PhD, ScD

  5. Department Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Julie E. Buring ScD

  6. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Peng-yun A. Huang MBBS, MPH

Authors
  1. Peng-yun A. Huang MBBS, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie E. Buring ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul M. Ridker MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert J. Glynn PhD, ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Glynn PhD, ScD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0144-1

KEY WORDS

Search

Navigation