A secondary prevention lipid clinic reaches low-density lipoprotein cholesterol goals more often than usual cardiology care with coronary heart disease (original) (raw)
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Lipid Management in High Risk Coronary Patients: How Effective are We at Secondary Intervention?
Heart, Lung and Circulation, 2012
To assess the proportion of patients who achieve and maintain target lipid levels during optimum long term follow up after coronary bypass surgery. Methods: From a prospectively compiled database, we identified 440 patients followed for up to 13 years after CABG as part of a radial artery randomised controlled trial. All available lipid assays conducted during the follow-up period were collected from pathology databases. These were used to calculate the annualised mean lipid exposure for each patient. Based upon National Heart Foundation guidelines, we determined the proportion of patients whose mean lipid exposure attained target levels (total cholesterol < 4.0 mmol/L, LDL-C < 2.0 mmol/L, HDL-C > 1.0 mmol/L and triglycerides < 1.5 mmol/L). This was compared with the proportion who had achieved these targets pre-operatively and on their most recent cholesterol measurement. Results: 6077 lipid studies (total cholesterol, LDL, HDL and triglycerides) in total were obtained. In those who had baseline data available, target levels for total cholesterol, HDL-C, LDL-C and triglycerides were attained pre-operatively by 16%, 64%, 14% and 39% of patients respectively. Annualised mean lipid exposures during up to 13 years of follow up for all patients revealed somewhat improved but still suboptimal target attainment figures of 24%, 83%, 20% and 53%. The most recent review shows the greatest improvement at 47%, 68%, 43% and 62% respectively. Of 141 diabetic patients, target attainment was significantly higher for total cholesterol (31%; p = 0.038) and LDL-C (28%; p = 0.006) but lower for HDL-C (75%; p = 0.002) and triglycerides (40%; p < 0.001). Conclusion: Despite some improvements seen over careful follow up, only HDL-C targets appear attainable for the majority of CABG patients. Over half still do not achieve non-HDL national lipid targets.
A national study on lipid management
European Journal of Internal Medicine, 2008
Background: Hyperlipidemia remains a major cause of morbidity in Western countries. The objective of this study was to document the percentage of adults who underwent periodical LDL measurement, and the percentage of patients with diabetes and post-angioplasty who were treated to goal. Methods: Using a national database, data were obtained on the percentage of adults who had an LDL performed and the percentage of adults with an LDL at pre-specified levels. We also assessed the attainment of target LDL levels in diabetic and post-angioplasty patients. Data were also collected from patients with an acute coronary syndrome (ACS) admitted to seven hospitals within a 5 year period (2000)(2001)(2002)(2003)(2004). Results: Primary prevention: In 2005, 64.6% of the total population of 754,910 aged 35-44 had at least one record of LDL cholesterol measurement documented. This figure was 79.6% in the 717,617 adults aged 45-54. Secondary prevention: Of 253,233 diabetics in 2005, 220,023 (86.9%) have undergone at least one annual LDL measurement. The percentage of patients on statin therapy 3 and 12 months after an ACS admission increased significantly during the years 2000-2004 and reached 87%. Of the 42,292 patients who underwent PTCA during 2005, 34,346 (81.2%) have purchased at least 3 prescriptions of statins during 2005, 35,261 (83.4%) have performed at least one LDL measurement and 57.8% attained an LDL level of b 100 mg/dl. Conclusions: We have shown an improvement in primary and secondary preventions of CV disease as documented by LDL measured and attainment of treatment goals, but further efforts are needed.
The Israel Medical Association journal : IMAJ, 2002
The implementation of treatment guidelines is lacking worldwide. To examine whether follow-up in a specialized lipid clinic improves the achievement rate of the treatment guidelines, as formulated by the National Cholesterol Education Program and the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The study group included patients who were referred to the lipid clinic because of hyperlipidemia. At each of five visits over a 12 month period, lipid levels, liver and creatine kinase levels, body mass index, and adherence to diet and medications were measured, and achievement of the NCEP target level was assessed. A total of 1,133 patients (mean age 61.3 years, 60% males) were studied. Additional risk factors for atherosclerosis included hypertension (41%), type II diabetes mellitus (21%), smoking (17%), and a positive family history of coronary artery disease (32%). All patients had evidence of atherosclerotic vas...
Clinical Research in Cardiology, 2011
Objectives According to various national and international guidelines, the target LDL-C level is\100 mg/dl for patients with established coronary heart disease (CHD) or CHD risk equivalent (CE). We aimed to investigate aspects of the lipid-lowering management of patients at high cardiovascular risk in-hospital care and the achievement of target values. Methods In the internet-based 2L registry in Germany (2005)(2006), cardiologists in 42 hospitals documented at a single visit 3,131 consecutive patients with known CHD, and/or diabetes mellitus, peripheral arterial disease, or a 10-year CHD risk [20% (summarized as CE), who were on chronic statin treatment. They received instructions on the guidelines and instant feedback on the effect of their treatment decisions (educational study component).
Iranian Red Crescent Medical Journal, 2013
Background: High cholesterol levels have long been considered an independent risk factor for cardiovascular disease (CVD). Objective: Controlling risk factors such as dyslipidemia in patients with coronary artery disease is necessary. We aimed to evaluate the success rate of lipid control, during 9 months follow-up after percutaneous coronary intervention (PCI). Patients and Methods: A total of 195 patients (67.7% men, mean age = 57.8 ± 9.4 years) who underwent PCI in Tehran Heart Center were included. Serum lipid profiles were measured in all the patients before PCI and at 9-month follow-up. Dyslipidemia was defined as serum levels of LDL-C ≥ 100 or TG ≥ 150 or TC ≥ 200 or HDL-C ≤ 40 mg/dl in the men and ≤ 50 mg/dl or less in the women, or non-HDL-C ≥ 130 mg/dl with or without the consumption of lipid-lowering agents. During follow up, all patients were given atorvastatin 20-40 mg/day. Results: Overall, 26.2% had diabetes mellitus, 42.6% had hypertension, and 34.9% were smokers. Dyslipidemia was more common in the women. At 9-month follow-up, there was no significant changes in terms of the prevalence of high HDL-C or low TG in patients; however, a significant increase was seen in the prevalence low TC in patients (63.6% vs. 80.5%; p value < 0.001), LDL-C (47.2% vs. 65.6%; p value < 0.001), and non-HDL-C (40.0% vs. 63.1%; p value < 0.001). Conclusions: Although by current treatments, the prevalence of patients with low TC, LDL-C and non-HDL-C has significantly increased; dyslipidemia persisted in a considerable proportion of patients. These results necessitate further investigations into the relationship between high serum lipids and long-term outcome of patients after PCI as well as further evaluations of the dyslipidemia treatment strategies.
The Status of Lipid Profile Control in Coronary Artery Disease Patients at a Tertiary Care Hospital
International Journal of Medical and Biomedical Studies
Background: Patients of coronary artery disease require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profile among CAD patients receiving statin therapy. To study THE STATUS OF LIPID PROFILE CONTROL IN CORONARY ARTERY DISEASE PATIENTS AT A TERTIARY CARE HOSPITAL Methods: Our study included 1016 patients with documented CAD by coronary angiography in Department of cardiology SMS medical college and associated group of hospitals. Patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and other cardiovascular risk factors. Results: In a total of 1016 patients (730 males and 286 females), (mean age 57.2 ± 8.8 years). Complete lipid profiles of 1016 patients were recorded. Regarding the CAD patients with complete lipid profiles, 72% had lag in lipid profile control as against the current guidelines in at least one of the three main lipid parameters: low-density lipoprote...
North Carolina Medical Journal, 2003
I t has been estimated that over 12 million Americans have coronary heart disease (CHD), the leading cause of death for both males and females; CHD costs the American economy in excess of 200 billion dollars annually. 1 One randomized trial has demonstrated that the most important of the multiple risk factors for CHD is an elevated cholesterol level. 2 The National Cholesterol Education Program (NCEP) has established guidelines for lowering cholesterol levels to improve management and outcomes of CHD. 3 Despite appeals to both the public and healthcare providers to screen and lower total and low density lipoprotein (LDL) cholesterol levels to current guidelines, multiple studies have continued to show low levels of cholesterol testing and poor results of treatment. 4-6 The nationwide Lipid Treatment Assessment Project (L-Tap) 7 and the North Carolina managed care study 8 both showed comparably poor results. Efforts to lower cholesterol levels by education and dietary intervention have met only with modest success. 9,10 The best success in cholesterol lowering has been achieved by drug therapy. 11-13 Lipid clinics that combine diet and drug therapy have been shown to produce significantly better hyperlipidemia management than that achieved in primary care practices. 14-15 The purpose of this study is to evaluate the success of a lipid clinic model that incorporates both the direct role of the primary care physician and nursing support staff in comparison with usual care. This community practice model employs a combination of techniques used in lipid clinics including instruction, education and optimal drug therapy with an emphasis on maintaining compliance. Methods Population: Men and women for both the study and control groups were selected from those with abnormal lipid profiles
Atherosclerosis, 2017
Background and aims. Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS). Methods. DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort). Results. A total of 10,661 patients were enrolled, 6,794 with stable CHD and 3,867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients who were female, obese, or current smokers were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely. Conclusions. Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT.
Achieving lipid targets in primary care settings
Current medical research and opinion, 2014
Achieving low-density lipoprotein cholesterol (LDL-C) goals in clinical practice is still unsatisfactory. Furthermore, a significant residual risk remains, even after reaching LDL-C targets, in terms of both fasting and postprandial triglycerides, high-density lipoprotein cholesterol (quantity and quality) and small dense LDL particles. Statins are the first choice for treating lipid abnormalities. Other lipid-lowering agents can be administered when statins are not tolerated and if LDL-C targets are not reached. Furthermore, multifactorial treatment, including a statin, exerts several beneficial effects on cardiovascular and residual risk reduction. The role of novel developing lipid therapies in clinical practice remains to be established.