Effectiveness of aggressive management of dyslipidemia in a collaborative-care practice model


      The Cardiovascular Risk Identification and Treatment Center was established in 1997, adopting a collaborative-care clinic model for the purpose of improving the management of high-risk patients with dyslipidemia. This was a retrospective analysis of 417 high-risk patients with ≥1 year of follow-up laboratory data. Analysis included changes in total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, triglycerides, and total cholesterol to HDL ratio; lipoprotein goal achievement; Framingham risk score; liver function; and cardiovascular events. At baseline, 66% of patients had coronary heart disease (CHD) or equivalent risk, 45% were not receiving dyslipidemia therapy, and 29% were on statin monotherapy. After 3 years in the program, 56% were receiving combination therapy, 41% were on monotherapy, and 2% were not on therapy. The 3 most common treatment regimens were statin plus niacin (36%), statin alone (22%), and niacin alone (14%). All lipoproteins improved from baseline (p <0.001). Overall, 62% to 74% of patients reached singular lipid goals and 35% achieved combined lipid goals. Patients with Framingham 10-year CHD risk of >20% were reduced from 6% to <1%. Only 29 patients (7.0%) had a cardiovascular event, including 5 (1.0%) who experienced a myocardial infarction. Aspartate aminotransferase/alanine transferase elevation >3 times normal occurred in 1% of patients. In conclusion, a collaborative-care practice model adopting individualized, aggressive pharmacologic and nonpharmacologic treatment strategies is highly effective in achieving lipid goals, is sustainable, and is safe. Furthermore, this approach yields reduced projected 10-year CHD risk. A low rate of cardiovascular events was observed.
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        • Bolton W.K.
        Nephrology nurse practitioners in a collaborative care model.
        Am J Kidney Dis. 1998; 31: 786-793
        • Rich M.W.
        • Beckham V.
        • Wittenberg C.
        • Leven C.L.
        • Freedland K.E.
        • Carney R.M.
        A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.
        N Engl J Med. 1995; 333: 1190-1195
        • DeBusk R.F.
        Cardiol Clin. 1996; 14: 143-157
        • Pollock M.L.
        • Franklin B.A.
        • Balady G.J.
        • Chaitman B.L.
        • Fleg J.L.
        • Fletcher B.
        • Limacher M.
        • Pina I.L.
        • Stein R.A.
        • Williams M.
        • Bazzarre T.
        AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular diseasebenefits, rationale, safety, and prescription.
        Circulation. 2000; 101: 828-833
      1. Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults. National Cholesterol Education Program (Adult Treatment Panel III): full report. Bethesda, MD: NIH National Heart, Lung, and Blood Institute. 2001:1–284

        • Sueta C.A.
        • Chowdhury M.
        • Boccuzzi S.J.
        • Smith Jr, S.C.
        • Alexander C.M.
        • Londhe A.
        • Lulla A.
        • Simpson Jr, R.J.
        Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease.
        Am J Cardiol. 1999; 83: 1303-1307
        • Pearson T.A.
        • Laurora I.
        • Chu H.
        • Kafonek S.
        The Lipid Treatment Assessment Project (L-TAP).
        Arch Intern Med. 2000; 160: 459-467
        • EUROASPIRE Study Group
        EUROASPIRE. A European Society of Cardiology survey of secondary prevention of coronary heart disease.
        Eur Heart J. 1997; 18: 1569-1582
        • Brown A.S.
        • Cofer L.A.
        Lipid management in a private cardiology practice (the Midwest Heart experience).
        Am J Cardiol. 2000; 85: 18A-22A
        • Shaffer J.
        • Wexler L.F.
        Reducing low-density lipoprotein cholesterol levels in an ambulatory care system.
        Arch Intern Med. 1995; 155: 2330-2335
        • Wolfe M.L.
        • Vartanian S.F.
        • Ross J.L.
        • Bansavich III, L.L.Mohler E.R.
        • Meagher E.
        • Friedrich C.A.
        • Rader D.J.
        Safety and effectiveness of niaspan when added sequentially to a statin for treatment of dyslipidemia.
        Am J Cardiol. 2001; 87: 476-479
        • Vacek J.L.
        • Dittmeier G.
        • Chiarelli T.
        • White J.
        • Bell H.H.
        Comparison of lovastatin (20 mg) and nicotinic acid (1.2 g) with either drug alone for type II hyperlipoproteinemia.
        Am J Cardiol. 1995; 76: 182-184
        • Brown B.G.
        • Zhao X.Q.
        • Chait A.
        • Fisher L.D.
        • Cheung M.C.
        • Morse J.S.
        • Dowdy A.A.
        • Marino E.K.
        • Bolson E.L.
        • Alaupovic P.
        • Frohlich J.
        • Albers J.J.
        Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
        N Engl J Med. 2001; 345: 1583-1592
        • Brown G.
        • Albers J.J.
        • Fisher L.D.
        • Schaefer S.M.
        • Lin J.T.
        • Kaplan C.
        • Zhao X.Q.
        • Bisson B.D.
        • Fitzpatrick V.F.
        • Dodge H.T.
        Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B.
        N Engl J Med. 1990; 323: 1289-1298
        • Carlson L.A.
        • Rosenhamer G.
        Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid.
        Acta Med Scand. 1988; 223: 405-418
        • Cashin-Hemphill L.
        • Mack W.J.
        • Pogoda J.M.
        • Sanmarco M.E.
        • Azen S.P.
        • Blankenhorn D.H.
        Beneficial effects of colestipol-niacin on coronary atherosclerosis.
        JAMA. 1990; 264: 3013-3017
        • Blankenhorn D.H.
        • Nessim S.A.
        • Johnson R.L.
        • Sanmarco M.E.
        • Azen S.P.
        • Cashin-Hemphill L.
        Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts.
        JAMA. 1987; 257: 3233-3240
        • Holmes C.L.
        • Schulzer M.
        • Mancini G.B.J.
        Angiographic results of lipid-lowering trials.
        in: Grundy S.M. Cholesterol-Lowering Therapy. Evaluation of Clinical Trial Evidence. Marcel Dekker, Inc, New York2000: 191-220