Lowering LDL cholesterol in adults: a prospective, community-based practice initiative

The purpose of our study was to see if a clinic-wide initiative, with low-density lipoprotein cholesterol (LDL)-lowering interventions, could be an effective health maintenance strategy to decrease LDL levels to <100 mg/dL in a community-based, internal medicine outpatient setting.

There were 1375 patients screened with an initial/baseline LDL (LDL(1)) measurement. Patients whose LDL(1) levels were >100 mg/dL were put on a lipid-lowering action plan and re-evaluated with a follow-up LDL (LDL(2)) in 3-4 months. An additional action plan was given to patients whose LDL(2) values were still too high, and their values retested in 3-4 months for a third LDL (LDL(3)). LDL(1) levels versus postintervention LDL measurement (LDL(2) or LDL(3)) levels were the primary endpoints, with secondary endpoints of total cholesterol, total triglyceride, and high-density lipoprotein cholesterol (HDL) levels over the 3 measurement periods.

Of 514 patients who were given action plans, 443 returned for their follow-up lipid assessment. LDL levels in this group fell from 140.7 +/- 29.2 (mean+/-1 SD) mg/dL (LDL(1)) to 110.9 (29.6) mg/dL (LDL(2)) (P <.05). Of these 443 patients, 167 individuals had LDL(2) levels that now met National Cholesterol Education Program/Third Adult Treatment Panel III guidelines (<100 mg/dL) and 87 were now considered by their primary care provider as controlled (LDL 100-130 mg/dL). However, 158 individuals had LDL(2) levels that were either not controlled or not meeting National Cholesterol Education Program/Third Adult Treatment Panel guidelines. These 158 patients were provided with a second action plan, and of these, 50 (32%) returned to the clinic for a third lipid panel. Their LDLs, as a group, subsequently fell from an LDL(2) of 139.9 (24.4) mg/dL to 112.5 (28.2) mg/dL (LDL(3)) (P <.05). Sixteen of 50 now had LDLs <100 mg/dL, and 26 of 50 were considered controlled. Initial HDL (HDL(1)) levels rose from 55.4 (17.2) mg/dL to 57.3 (14.6) mg/dL (HDL(2)) (n=443). Blood levels of triglycerides and cholesterol also decreased in our returning patients over this time period (P <.05).

Community-based physicians can help their patients realize significant reductions in low-density lipoprotein cholesterol levels by implementing and closely monitoring lipid-lowering initiatives for their patients, resulting in potentially large positive impacts on the long-term health and well-being of their patients.