Clinical treatment of dyslipidemia: practice patterns and missed opportunities

  • Sidney C Smith Jr.
    Address for reprints: Sidney C. Smith, Jr, MD, University of North Carolina, Division of Cardiology, 323 Burnett Womack, CB #7075, Chapel Hill, North Carolina 27599-7075
    Division of Cardiology, University of North Carolina Cardiovascular Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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      Studies have found that most dyslipidemic coronary artery disease and postsurgical cardiac patients are not monitored for serum lipids, especially high-density lipoprotein cholesterol (HDL-C). These patients are not prescribed lipid-altering therapy and are not treated to National Cholesterol Education Program (NCEP) target levels. When prescribed, the most commonly administered drugs are statins, followed by fibrates and niacin. Resins are the least commonly prescribed treatment for dyslipidemia. Unfortunately, drugs chosen are often not the best for each patient. To compound matters, compliance with lipid-modification therapy is poor. Nurse case-management programs, supportive regular contact with healthcare professionals, and immediate postinterventional initiation of therapy significantly improves compliance.
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        • Cohen M.V.
        • Byrn M.J.
        • Levine B.
        • Gutowski T.
        • Adelson R.
        Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease.
        Circulation. 1991; 83: 1294-1304
      1. Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease. A multicenter randomized trial: writing group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. JAMA 1997;277:715–721.

        • Pearson T.A.
        • Laurora I.
        • Chu H.
        • Kafonek S.
        The Lipid Treatment Assessment Project (L-TAP).
        Arch Intern Med. 2000; 160: 459-467
      2. Schrott HG, Bittner V, Vittinghoff E, Herrington DM, Hulley S, for the HERS Research Group. Adherence to National Cholesterol Education Program treatment goals in post-menopausal women with heart disease: The Heart and Estrogen/Progestin Replacement Study (HERS). Jama 1997;277:1281–1286.

        • Sueta C.A.
        • Chowdhury M.
        • Bocuzzi S.J.
        • Smith Jr, S.C.
        • Alexander C.M.
        • Loudhe A.
        • Lulla A.
        • Simpson Jr, R.J.
        Analysis of the degree of undertreatment of dyslipidemia and congestive heart failure secondary to coronary artery disease.
        Am J Cardiol. 1999; 83: 1303-1307
      3. The Expert Panel. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993;269:3015–3023.

        • Reichgott M.J.
        • Pearson S.
        • Hill M.N.
        The nurse-practitioner’s role in complex patient management.
        J Natl Med Assoc. 1983; 75: 1197-1220
        • Weinberger M.
        • Kirkman M.S.
        • Samsa G.P.
        • Shortliffe E.A.
        • Landsman P.B.
        • Cowper P.A.
        • Simal D.L.
        • Fuessner J.R.
        A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus.
        J Gen Intern Med. 1995; 10: 59-66
        • Taylor C.B.
        • Houston-Miller N.
        • Killen J.D.
        • DeBusk R.F.
        Smoking cessation after acute myocardial infarction.
        Ann Intern Med. 1990; 113: 118-1123
        • Blair T.P.
        • Bryant F.J.
        • Bocuzzi S.
        Treatment of hypercholesterolemia by a clinical nurse using a stepped-care protocol in a non-volunteer population.
        Arch Intern Med. 1988; 148: 1046-1048
        • DeBusk R.F.
        • Miller N.H.
        • Superko H.R.
        • Dennis C.A.
        • Thomas R.J.
        • Lew H.T.
        • Berger III, W.E.
        • Heller R.S.
        • Rompf J.
        • Gee D.
        • et al.
        A case management system for coronary risk factor modification after acute myocardial infarction.
        Ann Intern Med. 1994; 120: 721-729
      4. PCS (Prescription Card Services) Health Systems Inc. Minneapolis; June, 1998.

      5. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Kiratzka LF, Houston-Miller M, Kris-Etherton P, Krumholz HM, LaRosa J, et al. When to start cholesterol-lowering therapy in patients with coronary artery disease: a statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction. Circulation 1997;95:1683–1685.

      6. Fonarow C, Gawlinski A, Cardin S, Moughrabi S, Tillisch JI. Improved treatment of cardiovascular disease by implementation of a cardiac hospitalization atherosclerosis management program: CHAMP. Circulation 1997;96(suppl):67.

      7. Patient Compliance: Lipid Lowering Agents TOP Study. Merck & Co. Inc.; 1992.

      8. Kos Pharmaceuticals, Inc. Unpublished data on file.