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Lipid targets in clinical practice: successes, failures and lessons to be learned
M Dunne1, O Mac Ananey, C Markham
1Tallaght Hospital, Dublin, Co Dublin, Ireland.
Insights
This study found that a cardiovascular risk factor clinic had gaps in achieving lipid targets, especially for patients with high initial LDL cholesterol. Improved education and strategies are needed for better risk factor control.
Area of Science:
- Cardiology
- Public Health
- Clinical Pharmacy
Background:
- Optimal risk factor control is crucial for patients with established coronary heart disease (CHD+) and those at risk (CHD-).
- Cardiovascular risk factor clinics aim to manage multiple risk factors effectively.
Purpose of the Study:
- To assess the success rate of achieving lipid risk factor targets in a multiple risk factor clinic.
- To identify factors contributing to the achievement or non-achievement of targets.
Main Methods:
- A retrospective audit of 488 patients (112 CHD+, 376 CHD-) attending a Cardiovascular Risk Factor Clinic.
- Data collected from 2009-2010 at Tallaght Hospital, Dublin.
Main Results:
- Achieved targets included LDLc (54/62%), HDLc (67/67%), systolic BP (35/38%), diastolic BP (82/75%), smoking cessation (27/26%), BMI ≤ 30 (39/50%), and normal waist circumference (27/39%).
- Patients not meeting LDLc targets had lower lipid-lowering drug use and higher baseline LDLc levels.
Conclusions:
- Gaps exist in achieving target lipid levels within the multiple risk factor clinic.
- High initial LDLc and insufficient drug titration were noted.
- Factors like guideline changes, staff rotation, visit frequency, and target multiplicity may contribute. Enhanced education and algorithm-based strategies are recommended.
Introduction:
Optimal risk factor control is integral to managing patients with proven coronary heart disease (CHD+) and for those at risk of coronary heart disease (CHD-). The primary aim of the study was to assess the success rate of reaching lipid risk factor targets in a multiple risk factor clinic.
Methods:
A retrospective audit was conducted in 488 patients (CHD+, n = 112; CHD-, n = 376) who attended the Cardiovascular Risk Factor Clinic at Tallaght Hospital, Dublin in 2009 and 2010.
Results:
Risk factor targets achieved in CHD+ and CHD- patients were LDLc (54/62 %), HDLc (67/67 %), systolic blood pressure (35/38 %), diastolic blood pressure (82/75 %), smoking cessation (27/26 %), BMI ≤ 30 (39/50 %) and normal waist circumference (27/39 %). Patients not reaching LDLc targets were found to be receiving fewer lipid-lowering drugs and having higher LDL levels at the initial clinic visit than those reaching targets.
Discussion:
This retrospective audit highlights gaps in achieving target lipid levels at a multiple risk factor clinic level. High initial LDLc levels and lack of drug titration are evident. Guideline changes, staff rotation, clinic visit frequency and multiplicity of targets may be contributory. More emphasis needs to be placed on education and algorithm-based strategies to achieve better risk factor control.
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