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The value of a specialist lipid clinic
1Department of Clinical Biochemistry and Immunology, Peterborough and Stamford Hospitals Foundation NHS Trust, Peterborough, Cambridgeshire, UK. s.c.martin@doctors.org.uk
Insights
A cardiovascular risk factor clinic significantly reduced blood pressure and improved lipid levels, demonstrating its value in managing major cardiovascular disease risks. The clinic also diagnosed new cases of diabetes and hypothyroidism.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Effective management of major risk factors like hypertension, dyslipidemia, and glucose intolerance is crucial for CVD prevention.
- Specialist clinics can offer targeted interventions for high-risk individuals.
Purpose of the Study:
- To evaluate the effectiveness of a cardiovascular risk factor clinic over its initial three years.
- To assess the clinic's impact on key cardiovascular disease risk factors.
- To determine the value of such a specialized service in managing patient populations.
Main Methods:
- A retrospective database review was conducted.
- Data from 339 patients referred to the clinic were analyzed.
- Key metrics included blood pressure, smoking cessation rates, glucose tolerance, lipid profiles, and treatment costs.
Main Results:
- Significant reductions in blood pressure were observed in hypertensive patients.
- 9% of smokers achieved 12-month cessation, with 50% relapse.
- 40% of oral glucose tolerance tests were abnormal, identifying new cases of diabetes and impaired glucose tolerance.
- Lipid levels were significantly reduced through potent statins, combination therapy, and fibrates.
- Low-density lipoprotein (LDL) cholesterol decreased by 36%.
Conclusions:
- The clinic identified a high proportion (66%) of primary prevention referrals not meeting current treatment thresholds, highlighting the need for specialist care.
- The clinic successfully diagnosed and managed 39 patients with undiagnosed diabetes/impaired glucose tolerance and 12 with hypothyroidism.
- A 36% reduction in LDL cholesterol suggests a substantial decrease in future cardiovascular events, achieved at a marginal increase in drug costs.
Aims:
To establish the value of the first 3 years of a cardiovascular risk factor clinic in tackling the major risk factors for cardiovascular disease (CVD).
Methods:
A database review of all 339 patients referred to the clinic.
Results:
Blood pressure levels in the hypertensive patients were significantly reduced and 9% of the smokers managed to quit for 12 months, half of them subsequently relapsing. Ninety-eight oral glucose tolerance tests were performed and 40% were abnormal yielding 10 patients with hitherto unsuspected diabetes and 29 with impaired glucose tolerance. Sixty-four of the 97 referrals of patients in the primary prevention group (no evidence of CVD) were found to have calculated Framingham coronary heart disease risk estimates of < 15% per decade, the lowest being 0.3%. Lipid levels were significantly reduced in both the hypercholesterolaemic (n = 290) and hypertriglyceridaemic (n = 49) patient groups through the use of more potent statins, extensive use of combination therapy and appropriate use of fibrates and omega-3 fish oil supplements. The annual drug cost per patient treated only increased from 310.72 pounds sterling to 398.08 pounds sterling, yet there was a 3.5-fold increase in the number of patients achieving the General Medical Services 2 target of a total cholesterol < 5 mmol/l and a 4.5-fold increase in patients achieving the Joint British Societies 2 target of a low-density lipoprotein (LDL) cholesterol < 2 mmol/l.
Conclusion:
The need for a specialist clinic was demonstrated by the 66% of primary prevention referrals who did not meet the current NICE treatment threshold. Additionally, the clinic was able to diagnose and treat 39 patients with undiagnosed diabetes mellitus/impaired glucose tolerance and 12 with hypothyroidism. LDL cholesterol was reduced overall by 36% implying a greater than one-third reduction in future cardiovascular events before the improvements in blood pressure control and smoking cessation are included and this was achieved at marginal extra cost to the mean drug bill at referral.
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