Achieving National Cholesterol Education Program Goals
Achieving National Cholesterol Education Program Goals
National Cholesterol Education Program (NCEP) guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL for patients with coronary artery disease (CAD) and lipid-lowering therapy if LDL-C remains >100-130 mg/dL after dietary intervention. Studies consistently report that the majority of CAD patients do not achieve NCEP goals in clinical practice; we sought to determine if our practice fared better. We performed a retrospective chart review of 600 CAD patients followed by cardiologists. The mean age was 69, and 66% of patients were male. Of persons with a cardiology clinic lipid profile (60%), most (76%) achieved an LDL-C <100 mg/dL; however, only 61% were treated to the NCEP secondary goal of non-HDL-C <130 mg/dL. Of patients not at an LDL-C goal, 81% were on lipid-lowering therapy, but only 18% were on maximal statin doses and 6% on combination therapy. We concluded that the majority of CAD patients have had recent lipid measurements and are treated according to NCEP guidelines, but many patients remain on suboptimal therapy.
Coronary artery disease (CAD) is the most common cause of death in developed countries. Studies have firmly established the link between elevated low-density lipoprotein cholesterol (LDL-C) and CAD. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) have shown greater predictive value than LDL-C levels and have been designated as secondary treatment goals in the National Cholesterol Education Program (NCEP) guidelines.
Secondary prevention studies have consistently shown that aggressive lipid lowering decreases cardiovascular morbidity and mortality in patients with CAD. Based on this evidence, the NCEP has issued the Adult Treatment Panel III guidelines for the management of dyslipidemia. These guidelines recommend an LDL-C goal <100 mg/dL and initiation of lipid-lowering therapy (LLT) when LDL-C levels remain >100-130 mg/dL after dietary therapy. If the triglycerides (TGs) are also elevated, it is recommended that the non-HDL-C be treated to <130 mg/dL in CAD patients. Achieving NCEP goals in CAD patients is possible in the majority of patients with current LLT; marked reductions in morbidity and mortality are demonstrated when these goals are achieved.
Despite the benefits of LLT in CAD patients, published reports show that most patients with CAD are still not reaching an LDL-C <100 mg/dL. A primary care study from 1998 demonstrated that only 14% of CAD patients achieved an LDL-C <100 mg/dL; records from community hospitals showed that only 37% of all eligible patients with CAD were on LLT. Data from the Lipid Treatment Assessment Project demonstrated that only 18% of CAD patients achieved an LDL-C <100 mg/dL. Other studies have shown similar findings, but there are few recent reports regarding the achievement of goals in clinical practice. The National Health and Nutrition Examination Surveys (NHANES) report showed no significant differences in the average cholesterol levels in adults during 1999-2000 as compared with the period of 1988-1994.
With the utilization of reminder systems or case managers, 55%-65% of CAD patients successfully achieve an LDL-C <100 mg/dL; in specialized lipid clinics, ≤71% of patients achieved an LDL-C <100 mg/dL.This success, however, has not been reported in general private practice groups. For example, in 1999, the Quality Assurance Program reported that among 48,000 CAD patients across the United States (seen primarily by cardiologists), only 25% of patients with a lipid profile had an LDL-C <100 mg/dL.
There are limited data documenting why such a large number of patients are not reaching their target LDL-C levels or are not receiving LLT. We conducted a retrospective analysis of medical records at an urban cardiology clinic to determine if our own practice fared better. For patients with an LDL-C ≥100 mg/dL, a review of the chart was performed to determine why they were not at goal.
National Cholesterol Education Program (NCEP) guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL for patients with coronary artery disease (CAD) and lipid-lowering therapy if LDL-C remains >100-130 mg/dL after dietary intervention. Studies consistently report that the majority of CAD patients do not achieve NCEP goals in clinical practice; we sought to determine if our practice fared better. We performed a retrospective chart review of 600 CAD patients followed by cardiologists. The mean age was 69, and 66% of patients were male. Of persons with a cardiology clinic lipid profile (60%), most (76%) achieved an LDL-C <100 mg/dL; however, only 61% were treated to the NCEP secondary goal of non-HDL-C <130 mg/dL. Of patients not at an LDL-C goal, 81% were on lipid-lowering therapy, but only 18% were on maximal statin doses and 6% on combination therapy. We concluded that the majority of CAD patients have had recent lipid measurements and are treated according to NCEP guidelines, but many patients remain on suboptimal therapy.
Coronary artery disease (CAD) is the most common cause of death in developed countries. Studies have firmly established the link between elevated low-density lipoprotein cholesterol (LDL-C) and CAD. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) have shown greater predictive value than LDL-C levels and have been designated as secondary treatment goals in the National Cholesterol Education Program (NCEP) guidelines.
Secondary prevention studies have consistently shown that aggressive lipid lowering decreases cardiovascular morbidity and mortality in patients with CAD. Based on this evidence, the NCEP has issued the Adult Treatment Panel III guidelines for the management of dyslipidemia. These guidelines recommend an LDL-C goal <100 mg/dL and initiation of lipid-lowering therapy (LLT) when LDL-C levels remain >100-130 mg/dL after dietary therapy. If the triglycerides (TGs) are also elevated, it is recommended that the non-HDL-C be treated to <130 mg/dL in CAD patients. Achieving NCEP goals in CAD patients is possible in the majority of patients with current LLT; marked reductions in morbidity and mortality are demonstrated when these goals are achieved.
Despite the benefits of LLT in CAD patients, published reports show that most patients with CAD are still not reaching an LDL-C <100 mg/dL. A primary care study from 1998 demonstrated that only 14% of CAD patients achieved an LDL-C <100 mg/dL; records from community hospitals showed that only 37% of all eligible patients with CAD were on LLT. Data from the Lipid Treatment Assessment Project demonstrated that only 18% of CAD patients achieved an LDL-C <100 mg/dL. Other studies have shown similar findings, but there are few recent reports regarding the achievement of goals in clinical practice. The National Health and Nutrition Examination Surveys (NHANES) report showed no significant differences in the average cholesterol levels in adults during 1999-2000 as compared with the period of 1988-1994.
With the utilization of reminder systems or case managers, 55%-65% of CAD patients successfully achieve an LDL-C <100 mg/dL; in specialized lipid clinics, ≤71% of patients achieved an LDL-C <100 mg/dL.This success, however, has not been reported in general private practice groups. For example, in 1999, the Quality Assurance Program reported that among 48,000 CAD patients across the United States (seen primarily by cardiologists), only 25% of patients with a lipid profile had an LDL-C <100 mg/dL.
There are limited data documenting why such a large number of patients are not reaching their target LDL-C levels or are not receiving LLT. We conducted a retrospective analysis of medical records at an urban cardiology clinic to determine if our own practice fared better. For patients with an LDL-C ≥100 mg/dL, a review of the chart was performed to determine why they were not at goal.
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