Lowering LDL Cholesterol in Adults: A Prospective, Community-Based Practice Initiative

• Published in: The American journal of medicine Vol. 121; no. 7; pp. 604 - 610
• Main Authors: Coodley, Gregg O., MD, Jorgensen, Maryclair, MPH, Kirschenbaum, Jack, PhD, Sparks, Chieko, Zeigler, Lisa, Albertson, Barry D., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2008; Elsevier; Elsevier Sequoia S.A
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Ambulatory Care Facilities; Biological and medical sciences; Cholesterol; Cholesterol - blood; Cholesterol, LDL - blood; Community health care; Community-based internal medicine clinic; Diet; Exercise; Female; Follow-Up Studies; General aspects; Humans; Hypercholesterolemia - blood; Hypercholesterolemia - prevention & control; Hypolipidemic Agents - therapeutic use; Internal Medicine; Life Style; Lipids; Low density lipoprotein; Low-density lipoprotein cholesterol (LDL); Male; Medical research; Medical sciences; Middle Aged; Oregon; Practice Guidelines as Topic; Primary Health Care; Prospective Studies; Risk Assessment; Triglycerides - blood; Oregon; Low-density lipoprotein cholesterol (LDL); Community-based internal medicine clinic; Adults; Human; Medicine; Prospective; Professional practice; Adult; Cholesterol LDL; Community
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2008.02.031

Abstract Purpose The purpose of our study was to see if a clinic-wide initiative, with low-density lipoprotein cholesterol (LDL)-lowering interventions, could be an effective health maintenance strategy to decrease LDL levels to <100 mg/dL in a community-based, internal medicine outpatient setting. Methods There were 1375 patients screened with an initial/baseline LDL (LDL1 ) measurement. Patients whose LDL1 levels were >100 mg/dL were put on a lipid-lowering action plan and re-evaluated with a follow-up LDL (LDL2 ) in 3-4 months. An additional action plan was given to patients whose LDL2 values were still too high, and their values retested in 3-4 months for a third LDL (LDL3 ). LDL1 levels versus postintervention LDL measurement (LDL2 or LDL3 ) levels were the primary endpoints, with secondary endpoints of total cholesterol, total triglyceride, and high-density lipoprotein cholesterol (HDL) levels over the 3 measurement periods. Results Of 514 patients who were given action plans, 443 returned for their follow-up lipid assessment. LDL levels in this group fell from 140.7 ± 29.2 (mean ± 1 SD) mg/dL (LDL1 ) to 110.9 (29.6) mg/dL (LDL2 ) ( P <.05). Of these 443 patients, 167 individuals had LDL2 levels that now met National Cholesterol Education Program/Third Adult Treatment Panel III guidelines (<100 mg/dL) and 87 were now considered by their primary care provider as controlled (LDL 100-130 mg/dL). However, 158 individuals had LDL2 levels that were either not controlled or not meeting National Cholesterol Education Program/Third Adult Treatment Panel guidelines. These 158 patients were provided with a second action plan, and of these, 50 (32%) returned to the clinic for a third lipid panel. Their LDLs, as a group, subsequently fell from an LDL2 of 139.9 (24.4) mg/dL to 112.5 (28.2) mg/dL (LDL3 ) ( P <.05). Sixteen of 50 now had LDLs <100 mg/dL, and 26 of 50 were considered controlled. Initial HDL (HDL1 ) levels rose from 55.4 (17.2) mg/dL to 57.3 (14.6) mg/dL (HDL2 ) (n = 443). Blood levels of triglycerides and cholesterol also decreased in our returning patients over this time period ( P <.05). Conclusions Community-based physicians can help their patients realize significant reductions in low-density lipoprotein cholesterol levels by implementing and closely monitoring lipid-lowering initiatives for their patients, resulting in potentially large positive impacts on the long-term health and well-being of their patients.