Circulation, Vol 83, 1294-1304, Copyright © 1991 by American Heart Association
MV Cohen, MJ Byrne, B Levine, T Gutowski and R Adelson
BACKGROUND. Although specific guidelines for the treatment of
hypercholesterolemia have been published, it is not known whether
physicians treating patients likely to have lipid disorders have adopted
the recommendations. METHODS AND RESULTS. The approach of cardiologists to
the treatment of hypercholesterolemia in a metropolitan teaching hospital
was assessed by interviewing patients with chest pain who were admitted for
coronary angiography in 1988-1989 and by measuring fasting blood lipid
profiles. At 1 month and again 12- 24 months later, patients were contacted
by telephone to determine if there had been any changes in treatment. Of 95
patients evaluated, 81 had coronary artery disease. Only 17% of those with
high levels of total cholesterol and/or low density lipoprotein cholesterol
were being actively treated with diet and/or drugs. In the remaining
patients, either lipid studies had not been done or abnormal results had
not been addressed. There was little change in treatment approach during
the month after the diagnostic procedure. Furthermore, the experience was
similar in those patients subjected to coronary revascularization. One to 2
years after the initial intervention, 69 of the original study group could
be contacted again. Although active dietary or pharmacological therapy was
initiated in some individuals during this interval, it was stopped in
others. Thirty-five percent of hypercholesterolemic patients were receiving
targeted therapy. CONCLUSIONS. Thus, only a small proportion of patients
with documented coronary artery disease and hypercholesterolemia were being
actively treated for their lipid disorder, suggesting that the published
treatment guidelines have not yet been fully accepted. However, an
encouraging improvement in frequency of treatment of hypercholesterolemia
was documented during the 1-2-year observation period.
ARTICLES
Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease
Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467.
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