With economic growth and associated changes in lifestyle and diet, the level of serum cholesterol in the Chinese population has greatly increased[4, 16]. Dyslipidemia is a major pathogenic factor of atherosclerosis, and one of the independent risk factors for cardiovascular disease such as coronary heart disease and stroke[1, 5]. Increasing the awareness and management of patients with dyslipidemia has a positive impact on cardiovascular disease prevention. Despite this, numerous studies have revealed poor awareness and unsatisfactory treatment and control in many European countries, and extremely low rates of dyslipidemia in the Chinese population[3, 6, 8, 13]. It has been reported that the awareness, treatment, and control rates of dyslipidemia were comparatively low among Chinese adults aged 18 and above, at 10.93%, 6.84% and 35.3% respectively in 2010. We found similar results in this present study with rates of awareness and treatment among participants being 11.6% and 8.4% respectively. However, the rates in our study were significantly less than the 22.2% awareness of diagnosis and 46.1% receiving treatment among adults in Beijing, China in 2012. Out of the 615 dyslipidemia individuals in our study that were receiving treatment, 34.8% were under control. This is slightly lower than the 37.8% serum lipids control finding of Cai et al. among those with dyslipidemia receiving treatment. This indicates that dyslipidemia is an important health risk factors in the Jilin province. However, only limited studies on the influencing factors associated with awareness, treatment and control of dyslipidemia had been carried out in China. Hence our study aimed to examine the awareness, treatment, and control of dyslipidemia, and their influence factors in the Jilin province.
Because dyslipidemia is almost asymptomatic and its detection requires blood analysis which in most cases requested by a physician, ordinary residents are hardly aware of and being treated for dyslipidemia disease. The results of our study revealed that the awareness and treatment of dyslipidemia among our study population increased concomitantly with age. This is in line with other studies such as the rate of awareness among residents in Beijing being less than 15% among adults aged 45 and above, and the awareness rate also increasing with age among residents in Laiwu city, China. This means that as people advance in age, they become more concerned about their health, particularly being concerned about cardiovascular diseases, than younger individuals who are less likely to attach great importance to disease consciousness.
Several recent studies showed that education is positively associated with the awareness of dyslipidemia[10, 18, 20, 21]. The more an individual attains higher levels of education, the more likely awareness about health conditions, including dyslipidemia, increases. Regarding the determinants of awareness in our study, an increasing education level was associated with a higher level of dyslipidemia awareness.
Our study also showed that compared with manual workers, retired participants were more likely to be aware of their dyslipidemia condition and seek treatment. This may be related to retirees, students having more time to focus on their health, and tend to seek early management of any adverse health condition. However, manual workers always appear body fatigue after a whole day’s work, so they easily ignore the condition body health.
Obesity is an independent risk factor of dyslipidemia[17, 22]. Findings from the ORISCAV-LUX study revealed that obese subjects are more conscious of cardiovascular health risks than slim individuals. This is helpful in increase their awareness of the underlying silent metabolic pathologies associated with excess body weight. Our findings are consistent with other studies that overweight or obesity (BMI ≥ 24 kg/m2) is associated with higher levels of dyslipidemia awareness and treatment[19, 20, 23]. Individuals with BMI ≥ 24 kg/m2 tend to control their BMI at 24 kg/m2 or less, which helps in preventing 50-60% risk of hypertriglyceridemia in this population. However, among individuals receiving treatment, individuals with BMI ≥ 24 kg/m2 are less likely to have controlled dyslipidemia. This finding is similar to the results of Long’s study in 2007. The plausible explanation is that weight control is a lengthy process, and it is more difficult to control blood lipids in overweight or obese people.
People with a family history of dyslipidemia have a higher risk of developing dyslipidemia. In this study, we found that family history of dyslipidemia was a strong predictor of dyslipidemia awareness and treatment. Unsurprisingly, having a family member with dyslipidemia would increase the consciousness and alertness of the whole family with regards to dyslipidemia, and physicians tend to pay more attention to patients with a family history of dyslipidemia, as they tend to have increased risk of cardiovascular diseases.
Consistent with other findings, our study revealed physical activity is associated with lower levels of awareness and treatment of dyslipidemia. This may be explained by the fact that people who exercise regularly believe they are less likely to become sick, and therefore are less likely to be conscious of dyslipidemia.
Lower levels of awareness and treatment were found among alcohol drinkers and also lower levels of dyslipidemia control among cigarette smokers in the present study. This may be explained that the dyslipidemia patients who are alcohol drinkers and cigarette smokers usually receive advice on drinking and smoking cessation given by physicians, or it may be associated with alcohol drinkers and smokers’ lower level of concern about their own health[18, 25]. Several studies have found that lifestyle changes are effective in controlling serum blood lipids[8, 19, 26]. Thus it is important to emphasize the need for policies that improve healthy lifestyle.
The findings should be interpreted with an understanding of the following potential limitations. The cross-sectional nature of our study design means that causal associations can only be made with caution. As in many surveys, our serum lipid levels and the definitions of dyslipidemia awareness, treatment, and control were based on measurements taken during a single visit. Potential sources of bias include recall bias of self-reported information. Treatment and control rates were based on only pharmacological treatment of dyslipidemia, however, it is possible to control serum lipid by non-pharmacological means, such as diet and/or exercise. The Chinese criteria were adopted to define dyslipidemia; therefore, we could not directly compare our results with those from other countries.