Cardiovascular Disease - High Cholesterol

Why Is This Important?

High cholesterol is a risk factor for cardiovascular disease (i.e., heart attack, heart failure, or stroke). Regular physical activity and eating a healthy diet can help prevent high cholesterol and improve cholesterol levels that are not optimal. Smoking can decrease levels of "good" HDL cholesterol, which also increases risk for cardiovascular disease. If lifestyle changes aren't enough to bring cholesterol levels into a healthy range, the addition of medication can often lead to effective control.

Definition

Estimated percentage of New Mexican adults (ages 18 and over) who have ever been told by a doctor, nurse or other health professional that they have high cholesterol. The high cholesterol question is administered only in odd years.

Data Sources

• Behavioral Risk Factor Surveillance System Survey Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, together with New Mexico Department of Health, Injury and Behavioral Epidemiology Bureau.
  (https://www.nmhealth.org/about/erd/ibeb/brfss/)
• U.S. data source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trends Data.
  (https://www.cdc.gov/brfss/brfssprevalence)

How the Measure is Calculated

How Are We Doing?

The percentage of adults who have ever been told by a health professional that they had high cholesterol remained stable over the period 2011 through 2015. The 2017 age-adjusted prevalence of diagnosed high cholesterol was statistically significantly lower than that of 2011, 2013, and 2015.

How Do We Compare With the U.S.?

Compared to the US median, New Mexico's percent of adults who have ever been told they have high cholesterol by a health professional has been consistently lower.

What Is Being Done?

The NM Department of Health Heart Disease and Stroke Prevention (HDSP) Program within the Population and Community Health Bureau uses a comprehensive, evidence-based approach to promote healthy lifestyles focused on preventing, identifying and controlling high blood pressure and high cholesterol levels among New Mexican adults. Our mission is to improve the health of New Mexicans by implementing and evaluating effective strategies for cardiovascular disease prevention and management. The HDSP program and its partners work with communities, health systems, health care providers and other organizations across the state to implement activities that improve quality of care as it relates to blood pressure and cholesterol control. This will reduce CVD-related illness, save lives and be a valuable investment in population health. Program strategies include: * Assist health systems in tracking and monitoring clinical measures to improve health care quality and identify patients with high blood pressure * Encourage team-based care practices within health systems * Promote sustainability of community health workers/community health representatives/promotoras * Increase the use of self-measured blood pressure monitoring with clinical support * Facilitate referral of adults with high blood pressure or high blood cholesterol to community programs/resources * Advance health equity to improve health outcomes and quality of life * Increase the HDSP?s capacity to achieve and sustain program goals and strategies The HDSP program consults with populations that are disproportionately affected by cardiovascular disease and stroke and/or those that serve them to develop education and services that are culturally appropriate to these populations.

Evidence-based Practices

Evidence-based community health improvement ideas and interventions may be found at the following sites: - The Guide to Community Preventive Services - Health Indicators Warehouse - County Health Rankings - Healthy People 2020 Website Heart Disease and its complications can be prevented and managed through these strategies: * Clinical decision-support systems designed to assist healthcare providers in implementing clinical guidelines at the point of care. * Reducing out-of-pocket costs (ROPC) for patients with high blood pressure and high cholesterol. * Team-Based Care to Improve Blood Pressure Control. * Interventions engaging community health workers/community health representatives/promotoras * Implementing self-measured blood pressure monitoring interventions * Interactive digital interventions for blood pressure self-management * Mobile Health (mHealth) interventions for treatment adherence among newly diagnosed patients CDC recommends specific major activities to implement these seven effective strategies: 1) Clinical decision-support systems (CDSS) designed to assist healthcare providers in implementing clinical guidelines at the point of care. * Implementation of CDSS at clinics and sites that provide healthcare services along with providing technical assistance on proper use of these systems. * CDSS for cardiovascular disease prevention (CVD) include one or more of the following: * Reminders for overdue CVD preventive services including screening for risk factors such as high blood pressure, diabetes, and high cholesterol * Assessments of patients' risk for developing CVD based on their medical history, symptoms, and clinical test results * Recommendations for evidence-based treatments to prevent CVD, including intensification of treatment * Recommendations for health behavior changes to discuss with patients such as quitting smoking, increasing physical activity, and reducing excessive salt intake * Alerts when indicators for CVD risk factors are not at goal[[br]] 2) Reducing out-of-pocket costs (ROPC) for patients with high blood pressure and high cholesterol: * Reducing out-of-pocket costs involves program and policy changes that make cardiovascular disease preventive services more affordable. These services include: * Medications * Behavioral counseling (e.g. nutrition counseling) * Behavioral support (e.g. community-based weight management programs, gym membership) * Encouraging the delivery of preventive services in clinical and non-clinical settings (e.g. worksite, community). * Promoting interventions that enhance patient-provider interaction such as team-based care, medication counseling, and patient education. * Increasing awareness of covered services to providers and to patients with high blood pressure and high cholesterol using targeted messages. * Work with diabetes management and tobacco cessation programs to coordinate coverage for blood pressure and cholesterol management. [[br]] 3) Team-Based Care to Improve Blood Pressure Control: * Team-based care to improve blood pressure control is a health systems-level, organizational intervention that incorporates a multidisciplinary team to improve the quality of hypertension care for patients. * Provide technical assistance to facilitate communication and coordination of care support among various team members including the patient, the patient?s primary care provider, nurses, pharmacists, dietitians, social workers, and community health workers. * Enhance the use of evidence-based guidelines by team members. * Actively engage patients and populations at risk in their own care by providing educational materials, medication adherence support, and tools and resources for self-management (including health behavior change). 4) Interventions engaging community health workers/community health representatives/promotoras: * Screening and health education. CHWs screen for high blood pressure, cholesterol, and behavioral risk factors recommended by the United States Preventive Services Task Force (USPSTF); deliver individual or group education on CVD risk factors; provide adherence support for medications; and offer self-management support for health behavior changes, such as increasing physical activity and smoking cessation. * Outreach, enrollment, and information. CHWs reach out to individuals and families who are eligible for medical services, help them apply for these services, and provide proactive client follow-up and monitoring, such as appointment reminders and home visits. * Team-based care. As care team members, CHWs partner with clients and licensed providers, such as physicians and nurses, to improve coordination of care and support for clients. * Patient navigation. CHWs help individuals and families navigate complex medical service systems and processes to increase their access to care. * Community organizers. CHWs facilitate self-directed change and community development by serving as liaisons between the community and healthcare systems. 5) Implementing self-measured blood pressure monitoring interventions: * One-on-one patient counseling on medications and health behavior changes (e.g., diet and exercise) * Educational sessions on high blood pressure and blood pressure self-management * Access to electronic or web-based tools (e.g., electronic requests for medication refills, text or email reminders to measure blood pressure or attend appointments, direct communications with healthcare providers via secure messaging) 6) Interactive digital interventions for blood pressure self-management: In these interventions, patients who have high blood pressure use digital devices to receive personalized, automated guidance on blood pressure self-management. Devices include mobile phones, web-based programs, or telephones. Interactive content does not require direct input from a health professional. 7) Mobile Health (mHealth) interventions for treatment adherence among newly diagnosed patients: mHealth interventions for treatment adherence use mobile devices to deliver self-management guidance to patients who have been recently diagnosed with cardiovascular disease. Content must be accessible through mobile-phones, smartphones, or other hand-held devices. Interventions must include one or more of the following: * Text-messages that provide information or encouragement for treatment adherence * Text-message reminders for medications, appointments, or treatment goals * Web-based content that can be viewed on mobile devices * Applications (apps) developed or selected for the intervention with goal-setting, reminder functions, or both * An interactive component (i.e., patients enter personal data or make choices) that gives patients personally relevant, tailored information and feedback * Mobile communication or direct contact with a healthcare provider * Web-based content to supplement text-message interventions

Other Objectives

HP2020 objectives HDS-6, 7, and 8; HDS-13 - 13.4; HDS-14 - 14.4.

More Resources

1. Centers for Disease Control and Prevention, High Cholesterol website (www.cdc.gov/cholesterol) 2. New Mexico Behavioral Risk Factor Surveillance System, 2013-2017, via NMIBIS https://ibis.health.state.nm.us.