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

• Published in: The American journal of cardiology 2003-06, Vol.91 (12), p.1427-1431
• Main Authors: Ryan, Michael J, Gibson, Joan, Simmons, Phillip, Stanek, Eric
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cardiovascular disease; Cholesterol, HDL - blood; Cholesterol, HDL - drug effects; Cholesterol, LDL - blood; Cholesterol, LDL - drug effects; Cohort Studies; Cooperative Behavior; Coronary Artery Disease - epidemiology; Coronary Artery Disease - therapy; Drug Therapy, Combination; Effectiveness; Female; Follow-Up Studies; General and cellular metabolism. Vitamins; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hyperlipidemias - epidemiology; Hyperlipidemias - therapy; Hypolipidemic Agents - therapeutic use; Lipids; Male; Medical sciences; Middle Aged; Niacin - therapeutic use; Patient Care Team - standards; Pharmacology. Drug treatments; Retrospective Studies; Risk Factors; Risk Reduction Behavior; Time Factors; Treatment Outcome; Triglycerides - blood; United States
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(03)00393-X

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 20% were reduced from 6% to 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.