Student Works
Beaufort, SC

The medical school of the future

Impacts of Lifestyle Counseling in Rural South Carolina
to Reduce Hypercholestermolemia

At SOMA, students experience the “medical school of the future” through the innovative Clinical Presentation Curriculum. In this unique educational model, clinical and basic science are delivered in an integrated context, aligning to how patients present their health concerns to physicians. In addition, students are exposed to the most advanced technological resources to better understand their role in the healthcare of tomorrow.

The curriculum format itself is forward-thinking. Founded on the Osteopathic tenants of whole person healthcare, students are taught to address the root causes of disease rather than simply treat symptoms. After a thorough immersion in the science of osteopathic medicine, they then broaden their learning experience by applying this knowledge in clinical settings.

This innovative approach combines the best of both classroom instruction and service-oriented training to truly deliver the medical education of the future.

Contributors: Ryan Schmidt, Stephen Kwak, Natalie Daoud, Jeff Tingey
A.T. Still University - School of Osteopathic Medicine in Arizona, South Carolina Campus — Beaufort-Jasper-Hampton Comprehensive Health Services

Abstract

Background: Cardiovascular disease is the number one cause of death in the United States. High cholesterol is a major risk factor contributing to cardiovascular disease and can be prevented by simple interventions. Overall in the U.S., 16.3% of adults suffer from high cholesterol; in the state of South Carolina alone, 43% of adults are affected. In order to contribute to the prevention of hypercholesterolemia in our community, lifestyle and nutritional counseling was given to patients by ATSU-SOMA medical students at community health centers located in Beaufort, Jasper, and Hampton counties in South Carolina.

Objective: Provide lifestyle and nutritional counseling to patients with hypercholesterolemia and determine the impact of counseling in a 3 month period by ATSU-SOMA medical students at community health centers located in Beaufort, Jasper, and Hampton counties in South Carolina.

Method: At the start of participation, baseline lipid profiles were recorded from each participant. The counseling included patients being asked questions about their dietary habits. This was followed by a 5-10 minute presentation on ways to improve lifestyle and nutritional health. A summarized informational hand-out was given to each patient to take home with them. Lipid profiles were recorded again at their 3 month follow- up appointment. Results: Due to the limitations of our study, we are still awaiting follow-up lab results in order to make a good correlation between counseling patients on lifestyle modifications and the impact it had in our community. Conclusion: The prevalence of high cholesterol in South Carolina is above the national average and counseling must be done to monitor and help address this preventable condition. The lack of follow-up from patients and patient withdrawal reveals the need for more reliable and efficient ways to approach the study. Patients and physicians must work together to address this concern and make sure follow-up lab tests are done in order to monitor their efforts. Limitations: The largest limitation to this study was the short time frame for patient enrollment and data collection. As such, follow-up data was not obtained on many patients. In addition, many of the patients who were scheduled to follow-up and receive labs failed to keep their appointments and were therefore lost to follow-up. Lastly, patients also chose to voluntarily withdraw from the study and their information was removed from the data set. It is for the above mentioned reasons that no statistical data has been obtained. Thus, no results are reportable at this time.

Introduction

According to the Center for Disease Control and Prevention, the prevalence of high total cholesterol (240 mg/dl and above) in U.S. adults is 16.3 % which is about 1 out of every 6 persons. Additionally, the CDC reports that high levels of cholesterol are a risk factor for heart disease, which is a leading cause of death in the U.S. (Center for Disease Control and Prevention, 2010). Zhao et al. (2010) states that in men 20-50 years old there is a 20% increase in total and LDL-C, whereas in women 20-60 years old the increase is 30%. While women tend to have a greater increase in cholesterol, overall men carry the burden of high cholesterol. Race and ethnicity also play a role in high cholesterol with African Americans having higher total and LDL-C levels than Caucasians (Zhao et al., 2010). Using heart disease as a marker, Beaufort, Jasper, and Hampton counties in South Carolina had 353-442 deaths per 100,000 aged 35 and older from 2000-2006. In comparison to the national average of 428 deaths per 100,000, South Carolina has 447 deaths per 100,000 (Center for Disease Control and Prevention).

When treating a patient with hyperlipidemia, the initial goal is to make lifestyle changes. These changes should include weight reduction, low salt diet (DASH), reduced alcohol intake, smoking cessation, and increased physical activity (Bestermann et al.,2006). Following a nutritional plan such as, Dietary Approach to Stop Hypertension (DASH) can lower LDL-C levels. Weight reduction will also lower LDL-C levels as well as raise HDL-C levels (Bestermann et al., 2006). Physical activity can help reduce triglyceride levels, raise HDL-C levels, and assist in weight loss. Aerobic activity of at least 30-60 minutes a day is encouraged (Bestermann et al., 2006). Smoking can reduce HDL-C levels and alcohol use can increase triglyceride and HDL-C levels (Rader & Hobbs, 2008).

With the importance of diet and exercise in mind, our objective is to provide lifestyle and nutritional counseling to patients with hypercholesterolemia and determine the impact of counseling in a 3 month period.

Methods

At the start of participation, baseline lipid profiles were recorded from each participant. The counseling included patients being asked questions about their dietary habits. This was followed by a 5-10 minute presentation on ways to improve lifestyle and nutritional health. A summarized informational hand- out was given to each patient to take home with them. Lipid profiles were recorded again at their 3 month follow-up appointment.

Results

19 patients were initially enrolled in this study. 7 participants had no baseline labs for enrollment, and 1 withdrew from the study. 11 patients remained eligible for the study. However, all 11 patients did not follow up in 3 months and no lab data is available. Therefore, the results of the study are incomplete.

Conclusions

The results of this study were inconclusive due to reasons stated in the section on limitations. During the course of this research it became evident that dealing with issues such as, diet and lifestyle modifications, in addition to working with physicians and staff, was a daunting task. Many people in our community do not have the basic knowledge of how to eat healthy, nor do some have the resources to obtain or cook a healthy meal. In addition, many people in the community did not seem to have an awareness of the potential dangers of an unhealthy diet and lack of exercise. Education is a limiting factor and an effective measure when it comes to nutrition. Ng et al. (2011) found people in rural Sweden with lower education levels had higher triglyceride levels compared to people living in the city with higher education levels. Thus, intervention which includes educating patients on lifestyle modifications such as, exercise, portion control, and dietary foods can help improve cholesterol and overall health. In addition, Ockene et al. (1999) found combining physician counseling with office-support programs helped decrease weight, and saturated fat and LDL levels. Thus, a cooperative effort between patient, office staff, physician, and the community at large can produce better outcomes in terms of nutritional counseling and patients reaching their health goals. We conclude that further study is necessary in this area to obtain a better understanding of how best to both educate as well as motivate people to not only lessen the burden of current disease but to begin to prevent disease all together.

Limitations

The largest limitation to this study was the short time frame for patient enrollment and data collection. As such, follow-up data was not obtained on many patients. In addition, many of the patients who were scheduled to follow-up and receive labs failed to keep their appointments and were therefore lost to follow-up. Lastly, patients also chose to voluntarily withdraw from the study and their information was removed from the data set. It is for the above mentioned reasons that at this time no statistical data has been obtained. Thus, no results are reportable at this time.

Biliography

Bestermann, W., Houston, M., Basile, J., Egan, B., Ferrario, C., Lackland, D., Hawkins, R., Reed, J., Rogers, P., Wise, D., & Moore, M. (2006). Addressing the Global Cardiovascular Risk of Hypertension, Dyslipidemia, Diabetes Mellitus, and the Metabolic Syndrome in the Southeastern United States, Part II: Treatment Recommendations for Management of the Global Cardiovascular Risk of Hypertension, Dyslipidemia, Diabetes Mellitus, and the Metabolic Syndrome. The American Journal of Medical Sciences, 329 (6), 292–305.

Ng, N., Johnson, O., Lindahl, B., Norberg, M. (2012). A reversal of decreasing trends in population cholesterol levels in Vasterbotten County, Sweden. Global Health Action, 5:

Ng, N., Johnson, O., Lindahl, B., Norberg, M. (2012). A reversal of decreasing trends in population cholesterol levels in Vasterbotten County, Sweden. Global Health Action, 5: Ockene, I. S., Hebert, J. R., Ockene, J. K., Saperia, G. M., Stanek, E., Nicolosi, R., Merriam, P. A.,& Hurley, T. G. (1999). Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population. Archives of Internal Medicine, 159(7) retrieved from http://archinte.ama-assn.org/cgi/content/full/159/7/725 Rader, D. & Hobbs, H. (2008).Disorders of Lipoprotein Metabolism. In A.S. Fauci et al. (eds.), Harrison’s Principles of Internal Medicine. New York: McGraw Hill. S.C. Department of Health & Environmental Control. (2010). State of the heart. Retrieved from http://www.scdhec.gov/administration/library/ML-002149.pdf Zhao, X.Q. , Hodgson, J.M., Schleyer, A.M. (2010). Hyperlipidemia. Retrieved Nov 29 2011, from MDConsult.com.

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