Utilization and adherence to guideline-recommended lipid-lowering therapy at an academic medical center

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.

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Lipid Clinic is an Efficacious Model of Preventive Medicine

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-01-02 ◽

2021 ◽

Vol 17 (1) ◽

pp. 4-10

Author(s):

A. V. Blokhina ◽

A. I. Ershova ◽

A. N. Meshkov ◽

A. S. Limonova ◽

V. I. Mikhailina ◽

...

Keyword(s):

Lipid Metabolism ◽

Preventive Medicine ◽

Medical Center ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Medical Care System ◽

Lipid Clinic ◽

Lowering Therapy ◽

Target Values ◽

Very High

Aim. To characterize patients accessing lipid clinic and assess the efficiency of treatment in a specialized medical center.Material and methods. A retrospective analysis of the surviving medical records of outpatients who visited the lipid clinic of the National Research Center for Therapy and Preventive Medicine (Moscow, Russia) in 2011-2019 (n=675) was carried out. Cardiovascular risk (CVR) and target lipoproteins levels were evaluated in accordance with actual guidelines for the diagnostics and correction of dyslipidemias.Results. The mediana of lipid clinic patients age was 57 [46;65] years. Female persons attend lipid clinic more often (61.5%). 48.5% of patients had low density lipoprotein cholesterol (LDL-c) >4.9 mmol/L, 7.7% had triglycerides level >5.5 mmol/L. Most of the patients were diagnosed with type IIa hyperlipidemia (44,1%) or type IIb (28,0%). Inherited impaired lipid metabolism was diagnosed in 27.7% individuals. 12.7% of the patients had familial hypercholesterolemia, 57.4% – had secondary causes of impaired lipid metabolism. More than half of the patients (52.4%) had low or moderate CVR, 28.1% had a very high CVR. High or very high CVR individuals revisited the lipid clinic more often than people with lower risk (68.2% vs. 35.4%). Revisiting patients (25.4%) reached LDL-c targets more often (33.3% of very high CVR patients; 45.5% of moderate-risk people) than in ordinary outpatient practice. High-intensity statin therapy was recommended for 32% of patients, and combined lipid-lowering therapy – for 14.8%. Among very high CVR individuals, combined lipid-lowering therapy was prescribed for 38.5%. Given the lipid-lowering therapy prescribed in the lipid clinic, LDL-с<1.8 mmol/L and<1.5 mmol/L will be achieved at 40.7% and 32.9% of patients with very high СVR.Conclusion. Lipid clinic is an important part of the medical care system for long-term follow-up of patients with impaired lipid metabolism, and it is more efficient in achieving target values of lipids and correcting risk factors in comparison with the primary medical service.

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Lipid lowering therapy in CAD patients at Academic Medical Centers: undertreatment and evidence of a gender gap

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(98)81450-2 ◽

1998 ◽

Vol 31 ◽

pp. 186

Author(s):

M. Miller ◽

R.P. Byington ◽

D. Hunninghake ◽

C.D. Furberg ◽

B. Pitt

Keyword(s):

Gender Gap ◽

Academic Medical Centers ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Medical Centers ◽

Lowering Therapy ◽

Academic Medical

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Improved Triglycerides and Insulin Sensitivity with 3 Months of Acipimox in Human Immunodeficiency Virus-infected Patients with Hypertriglyceridemia

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1174 ◽

2006 ◽

Vol 91 (11) ◽

pp. 4438-4444 ◽

Cited By ~ 33

Author(s):

Colleen Hadigan ◽

James Liebau ◽

Martin Torriani ◽

Rebecca Andersen ◽

Steven Grinspoon

Keyword(s):

Insulin Sensitivity ◽

Medical Center ◽

Controlled Trial ◽

Academic Medical Center ◽

Fat Distribution ◽

Lipid Lowering ◽

Secondary Outcome ◽

Outcome Variable ◽

Lipid Lowering Therapy ◽

Men And Women

Abstract Context: Metabolic abnormalities such as hypertriglyceridemia remain a challenge for optimizing long-term health in HIV-infected patients. Objective: Elevation of free fatty acids (FFAs) may contribute to hyperlipidemia and insulin resistance in HIV. We evaluated the efficacy and safety of chronic inhibition of lipolysis in HIV-infected men and women with hypertrigyceridemia. We hypothesized that acipimox would lead to significant reductions in triglycerides and improved insulin sensitivity, compared with placebo. Design: A 3-month, randomized, double-blind, controlled trial of acipimox (250 mg thrice daily) vs. placebo was conducted in 23 HIV-infected men and women with hypertriglyceridemia (>150 mg/dl), abnormal fat distribution, and no current lipid-lowering therapy. The primary outcome variable was triglyceride concentration, and insulin sensitivity measured by hyperinsulinemic euglycemic clamp was a secondary outcome. Setting: The study was conducted at an academic medical center. Results: Acipimox resulted in significant reductions in FFAs [mean change −0.38 (0.06) vs. 0.08 (0.06) mEq/liter with placebo, −68 vs. +17% change from mean baseline, P < 0.0001], decreased rates of lipolysis (P < 0.0001), and a median triglyceride decrease from 238 mg/dl at baseline to 190 mg/dl, compared with an increase from 290 to 348 mg/dl in the placebo group (P = 0.01). Acipimox improved insulin sensitivity [acipimox +2.31 (0.74) vs. placebo −0.21 (0.90) mg glucose per kilogram lean body mass per minute, or +31 vs. −2% change from mean baseline values, P = 0.04]. Improvements in insulin sensitivity were significantly correlated with reductions in FFAs (r = −0.62, P = 0.003) and lipolysis (r = −0.59, P = 0.005). Conclusions: Acipimox resulted in significant sustained reductions in lipolysis, improved glucose homeostasis, and significant but modest reductions in triglycerides in HIV-infected individuals with abnormal fat distribution and hypertriglyceridemia. Improvement in overall metabolic profile with acipimox suggests a potential clinical utility for this agent that requires further investigation.

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