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      Survey of Physician’s Attitudes and Practices toward Lipid-Lowering Management Strategies


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          Background: The purpose of the present study was to examine physician’s attitudes and practices toward the use of different lipid-lowering management strategies in patients at increased risk for coronary heart disease (CHD). Aims/Methods: An internet-based questionnaire was completed by 78 general internists and family practitioners (mean age = 49 years; 80% male) affiliated with a large primary care health delivery system in Connecticut. Questions were asked about physician knowledge and use of current national guidelines for lipid-lowering therapy and their treatment practices for patients at varying risk for CHD. Results: Most physicians reported they were very knowledgeable about different interventions to lower serum lipids. Most (92%) indicated that they were aware of and followed national guidelines for the treatment of patients with hyperlipidemia the majority of the time. Physicians were likely to initiate lipid-lowering therapy at lower levels of serum LDL cholesterol in patients at high, as compared to those at moderate, risk for coronary disease. Targeted treatment levels were also reported to be considerably lower for patients at higher risk, than for those at moderate risk, for the development of coronary disease. Diabetes, cigarette smoking, and elevated LDL cholesterol levels were reported to be the three most important risk factors for CHD by the physician sample. Gaps in the recommendation of lifestyle changes to patients with hyperlipidemia were observed. Conclusions: Despite adequate physician knowledge, achieving desirable serum lipid levels in primary care patients remains elusive. Provider education is needed to optimize the care of patients with elevated serum lipids treated in the primary care setting.

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          Most cited references 5

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          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)

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            Lifetime risk of coronary heart disease by cholesterol levels at selected ages.

            We sought to assess how cholesterol levels at different ages modify the remaining lifetime risk of coronary heart disease (CHD). We included all Framingham Heart Study participants examined from 1971 through 1996 who did not have CHD and were not receiving lipid-lowering therapy. At index ages of 40, 50, 60, 70, and 80 years, participants were stratified by total cholesterol level and by cholesterol subfractions. Lifetime risk of CHD was calculated with death free of CHD as a competing event. Among 3269 men and 4019 women, 1120 developed CHD and 1365 died free of CHD during follow-up. At each index age, lifetime risk of CHD increased with higher cholesterol levels, and time to event decreased. At age 40 years, the lifetime risks of CHD through age 80 years for men with total cholesterol levels less than 200 mg/dL ( or =6.20 mmol/L), respectively, were 31%, 43%, and 57%; for women, the lifetime risks were 15%, 26%, and 33%, respectively. Lifetime risks contrasted sharply with shorter-term risks: at age 40 years, the 10-year cumulative risks of CHD were 3%, 5%, and 12% for men, and 1%, 2%, and 5% for women, respectively. Lifetime risk of CHD increases sharply with higher total cholesterol levels for men and women at all ages. These data support an important role for cholesterol screening in younger patients, and they may help target high-risk patients for lifestyle modification or drug therapy.
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              Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization.

              Published data indicate that there is a significant treatment gap between the evidence for and the implementation of lipid-lowering therapy and that recidivism is as high as 60% at 1 year. The aim of this study is to examine the impact of a clinical pharmacy cardiac risk service (CPCRS) on lipid screening, control, and treatment outcomes. A computer-generated list of all patients with documented coronary artery disease, enrolled in a CPCRS between March 1, 1998, and October 1, 2002, and followed up for a minimum of 6 months was obtained. Outcome measures were the percentage of patients with up-to-date lipid screening results and the percentage achieving low-density lipoprotein cholesterol (LDL-C) goals at enrollment in CPCRS and at study end. A total of 8014 patients (mean age, 69.3 years; 69.8% men) met the entry criteria. The mean duration of follow-up was 2.3 years. Most patients (97.3%) had up-to-date lipid screening results at study end compared with 66.9% of patients at baseline. At study end, a total of 72.9% of patients achieved a LDL-C level of less than 100 mg/dL (<2.6 mmol/L) compared with 25.5% at baseline. The mean +/- SD LDL-C level for the cohort at study end was 89 +/- 24 mg/dL (2.3 +/- 0.6 mmol/L). Of patients receiving medication, most (84.8%) were receiving therapy with statins alone, whereas 11.7% were receiving combination therapy. A CPCRS working in conjunction with a patient-tracking system can achieve improved lipid results in a large and inclusive cohort of patients with coronary artery disease. Our approach is unique in that the results were sustainable and demonstrate reduced recidivism.

                Author and article information

                S. Karger AG
                May 2007
                30 January 2007
                : 107
                : 4
                : 302-306
                aDivision of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Mass., bProHealth Physicians, Inc., Farmington, Conn., and cAstra Zeneca, Wilmington, Del., USA
                99066 Cardiology 2007;107:302–306
                © 2007 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 3, References: 12, Pages: 5
                Original Research


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