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Lipid lowering in the cardiac rehabilitation setting
P A Ades1, P D Savage, E T Poehlman
1Cardiac Rehabilitation Program, University of Vermont College of Medicine Fletcher-Allen Health Care, Burlington.
Purpose:
The authors determined the frequency and effectiveness of pharmacologic lipid lowering, guided by the recommendations of the National Cholesterol Education Program (NCEP) before and after institution of a systematic lipid assessment performed at the time of the cardiac rehabilitation entry evaluation.
Methods:
The systematic lipid evaluation included a full lipid profile and a dietary evaluation at which time an active approach to pharmacologic lipid therapy was taken. Therapy was guided by the NCEP guidelines, with the collaboration of the referring physician. The frequency of lipid therapy change (starting or changing therapy) from the baseline evaluation to a 3-month follow-up visit was the primary study outcome variable. The control group consisted of 51 patients with coronary heart disease (CHD) seen in 1995 at cardiac rehabilitation, who agreed to have their serum lipids measured in a double-blinded fashion. There was no systematic lipid lowering intervention. The intervention group consisted of 187 patients with CHD who participated in cardiac rehabilitation in 1996 to 1997.
Results:
At baseline, a similar percentage of patients in each group were on lipid lowering therapy: 38% (19/51) in controls versus 35% (65/187) in intervention patients. Among patients with a baseline low-density lipoprotein (LDL) cholesterol of > or = 130 mg/dL, therapy was modified in 18% (4/22) of control patients compared with 52% (35/68) of intervention patients (P < 0.05). Among patients with a baseline LDL cholesterol of > or = 160, therapy was altered in 22% (2/9) control patients compared with 72% (18/25) intervention patients (P < 0.01). In both risk strata of > or = 130 mg/dL and > or = 160 mg/dL, LDL cholesterol measures were lowered to a greater degree in the intervention group.
Conclusions:
The performance of a systematic lipid review at the time of cardiac rehabilitation entry, with an active stance toward pharmacologic therapy, results in a threefold increase in pharmacologic modifications and lower LDL cholesterol values for cardiac rehabilitation participants.