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Lowering LDL cholesterol in adults: a prospective, community-based practice initiative.
Am J Med 2008; 121(7):604-10AJ

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 (LDL(1)) measurement. Patients whose LDL(1) levels were >100 mg/dL were put on a lipid-lowering action plan and re-evaluated with a follow-up LDL (LDL(2)) in 3-4 months. An additional action plan was given to patients whose LDL(2) values were still too high, and their values retested in 3-4 months for a third LDL (LDL(3)). LDL(1) levels versus postintervention LDL measurement (LDL(2) or LDL(3)) 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 (LDL(1)) to 110.9 (29.6) mg/dL (LDL(2)) (P <.05). Of these 443 patients, 167 individuals had LDL(2) 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 LDL(2) 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 LDL(2) of 139.9 (24.4) mg/dL to 112.5 (28.2) mg/dL (LDL(3)) (P <.05). Sixteen of 50 now had LDLs <100 mg/dL, and 26 of 50 were considered controlled. Initial HDL (HDL(1)) levels rose from 55.4 (17.2) mg/dL to 57.3 (14.6) mg/dL (HDL(2)) (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.

Authors+Show Affiliations

Fanno Creek Clinic, LLC, Portland, Ore, USA. coodley@fannocreek.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18538295

Citation

Coodley, Gregg O., et al. "Lowering LDL Cholesterol in Adults: a Prospective, Community-based Practice Initiative." The American Journal of Medicine, vol. 121, no. 7, 2008, pp. 604-10.
Coodley GO, Jorgensen M, Kirschenbaum J, et al. Lowering LDL cholesterol in adults: a prospective, community-based practice initiative. Am J Med. 2008;121(7):604-10.
Coodley, G. O., Jorgensen, M., Kirschenbaum, J., Sparks, C., Zeigler, L., & Albertson, B. D. (2008). Lowering LDL cholesterol in adults: a prospective, community-based practice initiative. The American Journal of Medicine, 121(7), pp. 604-10. doi:10.1016/j.amjmed.2008.02.031.
Coodley GO, et al. Lowering LDL Cholesterol in Adults: a Prospective, Community-based Practice Initiative. Am J Med. 2008;121(7):604-10. PubMed PMID: 18538295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lowering LDL cholesterol in adults: a prospective, community-based practice initiative. AU - Coodley,Gregg O, AU - Jorgensen,Maryclair, AU - Kirschenbaum,Jack, AU - Sparks,Chieko, AU - Zeigler,Lisa, AU - Albertson,Barry D, Y1 - 2008/06/04/ PY - 2007/10/04/received PY - 2008/02/15/revised PY - 2008/02/20/accepted PY - 2008/6/10/pubmed PY - 2008/7/30/medline PY - 2008/6/10/entrez SP - 604 EP - 10 JF - The American journal of medicine JO - Am. J. Med. VL - 121 IS - 7 N2 - 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 (LDL(1)) measurement. Patients whose LDL(1) levels were >100 mg/dL were put on a lipid-lowering action plan and re-evaluated with a follow-up LDL (LDL(2)) in 3-4 months. An additional action plan was given to patients whose LDL(2) values were still too high, and their values retested in 3-4 months for a third LDL (LDL(3)). LDL(1) levels versus postintervention LDL measurement (LDL(2) or LDL(3)) 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 (LDL(1)) to 110.9 (29.6) mg/dL (LDL(2)) (P <.05). Of these 443 patients, 167 individuals had LDL(2) 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 LDL(2) 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 LDL(2) of 139.9 (24.4) mg/dL to 112.5 (28.2) mg/dL (LDL(3)) (P <.05). Sixteen of 50 now had LDLs <100 mg/dL, and 26 of 50 were considered controlled. Initial HDL (HDL(1)) levels rose from 55.4 (17.2) mg/dL to 57.3 (14.6) mg/dL (HDL(2)) (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. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/18538295/Lowering_LDL_cholesterol_in_adults:_a_prospective_community_based_practice_initiative_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(08)00251-9 DB - PRIME DP - Unbound Medicine ER -