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Management of hyperlipidemia in patients with vascular disease
Maria C Cote1, Robert Ligeti, Bruce S Cutler
1Division of Vascular Surgery, University of Massachusetts Memorial Medical Center, Worcester, 01655, USA.
Insights
Lipid management in patients with peripheral arterial disease (PAD) is often inadequate. A study found only 42% of patients undergoing vascular surgery met low-density lipoprotein (LDL) goals, indicating a need for improved lipid control strategies.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Lipidology
Background:
- Atherosclerosis is a leading cause of death and peripheral arterial disease (PAD).
- Aggressive lipid management improves outcomes in coronary artery disease (CAD), but is less studied in PAD.
- National Cholesterol Education Program (NCEP) guidelines exist for lipid treatment in atherosclerotic disease.
Purpose of the Study:
- To assess current lipid management effectiveness in patients undergoing elective peripheral vascular surgery.
- To identify methods for improving compliance with NCEP guidelines in PAD patients.
Main Methods:
- Retrospective review of 105 patients scheduled for elective vascular procedures.
- Analysis of medical history, risk factors, and lipid medications.
- Comparison of preoperative lipid profiles with NCEP guidelines.
Main Results:
- Lipid profiles were available for 85 of 105 patients.
- Only 42% of patients met the NCEP recommended low-density lipoprotein (LDL) goal (<100 mg/dL).
- Over half of patients had a history of atherosclerosis or bypass surgery.
Conclusions:
- A minority of patients with PAD undergoing vascular surgery achieve NCEP lipid goals.
- More aggressive evaluation and treatment of lipid disorders in PAD patients are warranted.
- Improved lipid management is crucial for patients with atherosclerotic disease and PAD.
Abstract:
Atherosclerosis contributing to cardiovascular disease is the leading cause of death in the United States. It is also the major cause of peripheral arterial disease (PAD). Although there is substantial evidence that aggressive treatment of hyperlipidemia improves the outcome of patients with coronary artery disease (CAD), relatively little attention has been directed toward lipid control in patients with PAD. The National Cholesterol Education Program (NCEP) has established guidelines for treatment of lipids in patients with atherosclerotic disease. The purpose of this study was to determine the effectiveness of current lipid management practices in patients electively admitted for peripheral vascular surgery and to explore methods to improve compliance with NCEP guidelines. The past medical/surgical history, risk factors for atherosclerosis, and medication regimen including lipid medications were obtained from a retrospective review of the medical records of 105 consecutive patients scheduled for an elective vascular procedure. Lipid profiles were obtained as part of their routine preoperative assessment and the results were compiled and compared with established NCEP guidelines to determine the level of compliance in our PAD population. Eighty-five of the 105 patients had lipid profiles recorded in the medical record. Only 42% of patients were at or below the recommended goal of less than 100 mg/dL for low-density lipoprotein (LDL). Greater than half of patients had previous diagnosis of atherosclerosis or had previous bypass including coronary artery bypass surgery. Despite the strong emphasis on lipid reduction, especially LDL cholesterol, only a minority of patients admitted for peripheral vascular surgery were at the recommended NCEP goal. More aggressive evaluation and treatment of lipid disorders in patients with PAD seems warranted.