Abstract
Introduction
Optimal risk factor control is integral to managing patients with proven coronary heart disease (CHD+) and for those at risk of coronary heart disease (CHD−). The primary aim of the study was to assess the success rate of reaching lipid risk factor targets in a multiple risk factor clinic.
Methods
A retrospective audit was conducted in 488 patients (CHD+, n = 112; CHD−, n = 376) who attended the Cardiovascular Risk Factor Clinic at Tallaght Hospital, Dublin in 2009 and 2010.
Results
Risk factor targets achieved in CHD+ and CHD− patients were LDLc (54/62 %), HDLc (67/67 %), systolic blood pressure (35/38 %), diastolic blood pressure (82/75 %), smoking cessation (27/26 %), BMI ≤ 30 (39/50 %) and normal waist circumference (27/39 %). Patients not reaching LDLc targets were found to be receiving fewer lipid-lowering drugs and having higher LDL levels at the initial clinic visit than those reaching targets.
Discussion
This retrospective audit highlights gaps in achieving target lipid levels at a multiple risk factor clinic level. High initial LDLc levels and lack of drug titration are evident. Guideline changes, staff rotation, clinic visit frequency and multiplicity of targets may be contributory. More emphasis needs to be placed on education and algorithm-based strategies to achieve better risk factor control.
Similar content being viewed by others
References
Verschuren WM, Jacobs DR, Bloemberg BP et al (1995) Serum total cholesterol and long-term coronary heart disease mortality in different cultures: twenty-five year follow-up of the Seven Countries Study. JAMA 274:131–136
MacMahon S, Peto R, Cutler J et al (1990) Blood pressure, stroke, and coronary heart disease, I: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765–774
Stamler J, Vaccaro O, Neaton JD et al (1993) Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16:434–444
Novello AC (1990) The health benefits of smoking cessation: a report of the surgeon general. Md: US dept of health and human services. DHHS publication (CDC), Rockville, pp 90–8416
Canoy D, Boekholdt SM, Wareham N et al (2007) Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation into Cancer and Nutrition in Norfolk cohort. A population-based prospective study. Circulation published online, doi: 10.1161/CIRCULATIONAHA.106.673756
Kotseva K, Wood D, De Backer G et al (2009) Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 373:929–940
Warnick GR, Knopp RH, Branson L et al (1990) Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints. Clin Chem 36(1):15–19
Waters DD, Brotons C, Chiang CW et al (2009) Lipid treatment assessment project 2 investigators. Lipid treatment assessment project 2: a multinational survey to evaluate the proportion of patients achieving low-density lipoprotein cholesterol goals. Circulation 120(1):28–34 Epub 2009 Jun 22
Karalis DG, Subramanya RD, Hessen SE et al (2011) Achieving optimal lipid goals in patients with coronary artery disease. Am J Cardiol 107(6):886–890 Epub 2011 Jan 19
Euroaspire, II study group (2001) Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 22:554–572
Hausenloy DJ, Yellon DM (2008) Targeting residual cardiovascular risk: raising high-density lipoprotein cholesterol levels. Heart 94:706–714
Sviridov D, Nestel P, Watts G (2007) Statins and metabolism of high density lipoprotein. Cardiovasc Hematol Ag Med Chem 5:215–221
Nicholls SJ (2012) The AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: impact on global health outcomes) trial: to believe or not to believe? J Am Coll Cardiol 59(23):2065–2067
Chapman JM, Ginsberg HN, Amarenco P et al (2011) Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J. doi:10.1093/eurheartj/ehr112
Schotte DE, Stunkard AJ (1990) The effects of weight reduction on blood pressure in 301 obese patients. Arch Intern Med 150(8):1701–1704
Myers MG, Godwin M, Dawes M et al (2011) Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 7(342):d286. doi:10.1136/bmj.d286
Law M, Wald N, Morris J (2003) Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy. Health Technol Assess 7(31):1–94
Aberg A, Bergstrand R, Johansson S et al (1983) Cessation of smoking after myocardial infarction: effects on mortality after 10 years. BR Heart J 49:416–422
Secades-Villa R, Alonso-Perez F, Garcia-Rodriguez O et al (2009) Effectiveness of three intensities of smoking cessation treatment in primary care. Psychol Rep 105:747–758
Klein S, Lora E, Burke RN et al (2004) Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation 110:2952–2967
Pagotto U, Vanuzzo D, Vicennati V et al (2008) Pharmacological therapy of obesity. G Ital Cardiol 9(4 Suppl 1):83S–93S
Ward M, McGee H, Morgan K et al (2007) SLÁN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. One Island–One Lifestyle? Health and lifestyles in the Republic of Ireland and Northern Ireland: comparing the population surveys SLÁN 2007 and NIHSWS 2005. Department of Health and Children. The Stationery Office, Dublin
Padwal RS, Rucker D, Li SK et al (2003) Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev 4 Art. No: CD004094. doi: 10.1002/14651858.CD004094.pub2
Acknowledgments
This audit was funded by a generous grant from Merck, Sharp and Dohme Ireland without whom this audit would not have been possible.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dunne, M., Mac Ananey, O., Markham, C. et al. Lipid targets in clinical practice: successes, failures and lessons to be learned. Ir J Med Sci 182, 673–678 (2013). https://doi.org/10.1007/s11845-013-0954-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-013-0954-6