Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease.

Cohen, Melanie; Byrne, Michael; Levine, Barbara; Gutowski, Ted; Adelson, R

doi:10.1161/01.cir.83.4.1294

Cited by 129 publications

(60 citation statements)

References 63 publications

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“…Numerous studies of individuals with cardiac disease have implied that appropriate treatment of cholesterol levels has been suboptimal. [13][14][15][16][17] This study suggests that the same may be true for patients with ischemic stroke at high vascular risk.…”

Section: Low-density Lipoprotein Cholesterol Concentrations Above Thementioning

confidence: 99%

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

et al. 2006

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Abstract-Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data. Results: Of 2,894 subjects in the analysis dataset, 38% were women; 71% were recruited in the United States and 29% in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level Ն130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42% had an LDL Յ100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease. Conclusions: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.

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Section: Low-density Lipoprotein Cholesterol Concentrations Above Thementioning

confidence: 99%

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

et al. 2006

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“…Despite the comprehensive nature and wide dissemination of NCEP-ATPII, a number of studies [6][7][8][9] published between the 1988 and 1993 reports documented that patients continued to be underscreened and undertreated for cardiovascular risk factors, especially hyperlipidemia. One recent study of postmenopausal women enrolled after the publication of NCEP-ATPII suggested persistent deficits in adherence to treatment goals.…”

mentioning

confidence: 99%

Physician Noncompliance With the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines

et al. 1998

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Background-We sought to determine the frequency with which physicians follow National Cholesterol Education Program (NCEP-ATPII) guidelines in screening for cardiovascular risk factors and treating hyperlipidemia. Methods and Results-We conducted a retrospective chart review on randomly sampled charts of 225 patients admitted to the coronary care unit between January and June 1996. The main outcome measures were rates of physician screening for coronary heart disease risk factors; rates of counseling for cigarette cessation, diet, and exercise; and extent of use of NCEP algorithms for obtaining LDL cholesterol values and treating hypercholesterolemia. Screening rates for interns (who performed best) were: cigarette use (89%), known coronary heart disease (74%), hypertension (68%), hyperlipidemia (59%), family history (56%), diabetes (37%), postmenopausal hormone therapy (11%), and premature menopause (1%). Four percent of smokers were counseled to quit, 14% of patients were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indicated on the basis of NCEP criteria. Patients were more likely to receive lipid-lowering treatment if NCEP criteria indicated that they should, but 36% of hospitalized patients and 46% of patients who should have been treated on discharge were not. Conclusions-Physicians are poorly compliant with NCEP guidelines for risk factor assessment and counseling, even in patients at high risk for coronary heart disease. Physicians follow NCEP-ATPII algorithms for obtaining an LDL value, a key step in evaluating the need for treatment, only 50% of the time. NCEP criteria seem to influence the decision to initiate lipid-lowering therapy, but significant numbers of eligible patients remain untreated. (Circulation. 1998;98:851-855.)

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“…In a weighted regression analysis a 2.5% reduction in the inci dence of coronary artery disease could be demonstrated for each 1 % reduction in T-C levels. A reduction in total serum cholesterol levels from 7 to 6 mmol/l in a popula tion would reduce total mortality by about 12% [14], Fol lowing the publication of the AHA recommendations for treatment of hyperlipidemia, a study was performed to evaluate how cardiologists treat hyperlipidemia [8], Only 17% of patients with proven coronary artery disease and elevated total serum cholesterol levels and/or elevated LDL-C were receiving lipid-lowering therapy with diet and/or drugs. After coronary angiography 25.9% were actively treated, and 12-24 months after the coronary angiography and possible revascularization, 35.5% of pa tients with elevated levels of serum cholesterol were receiving lipid-lowering therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This is usually not the case in daily clinical practice. Furthermore, it has been reported that only a small proportion of hypercholesterolemic patients undergoing coronary revascularization is receiving sufficient lipid-lowering therapy [8],…”

Section: Introductionmentioning

confidence: 99%

Dyslipidemia and Coronary Artery Disease

Rohold¹,

Haastrup²,

Larsen³

et al. 1996

Cardiology

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A reduction in serum total cholesterol (T-C) levels has been shown to reduce mortality in patients with coronary artery disease and to decrease the need for revascularization. To examine the prevalence and treatment of lipid disorders in patients referred for their first coronary angiogram, medical history and fasting blood samples were collected in 108 consecutive patients. Ninety-one patients (84.3%) fulfilled the criteria for dyslipidemia. Hypercholesterolemia had previously been demonstrated in 53 patients (49.1%), and 34 (64.2%) of these patients still had T-C > 6.0 mmol/l at the time of admission. Among 55 patients who were unaware of any lipid disorders at admission, 28 (50.9%) had T-C > 6.0 mmol/l. Conclusion: the majority of patients referred for their first coronary angiogram and possible revascularization suffered from dyslipidemia. Many patients with previously recognized dyslipidemia were insufficiently treated.

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Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease.

Cited by 129 publications

References 63 publications

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

Physician Noncompliance With the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines

Dyslipidemia and Coronary Artery Disease

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