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Treatment of hypercholesterolemia in patients undergoing multiple coronary angioplasties
V Marques1, S Bowser, J Hendrickxs
1Dept. of Medicine, Shadyside Hospital, Pittsburgh, Pennsylvania 15232, USA.
Insights
Many patients with hypercholesterolemia undergoing angioplasty (PTCA) are not adequately treated or monitored. This study found suboptimal cholesterol management in a significant percentage of these high-risk cardiovascular patients.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Research
Background:
- Hypercholesterolemia is a significant risk factor for coronary artery disease (CAD).
- Lipid-lowering therapy can reduce CAD progression and improve mortality.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization procedure for CAD patients.
Purpose of the Study:
- To investigate the prevalence of hypercholesterolemia treatment in patients undergoing elective PTCA.
- To assess whether patients achieved desirable cholesterol levels before PTCA.
- To evaluate the adequacy of lipid management in patients with a history of hypercholesterolemia and PTCA.
Main Methods:
- Retrospective chart review of 129 patients undergoing elective PTCA between September 1993 and August 1994.
- Inclusion criteria: history of hypercholesterolemia and at least one prior PTCA.
- Exclusion criteria: PTCA for acute events, no history of hypercholesterolemia.
Main Results:
- Cholesterol levels were unavailable for 13 patients; 116 patients were analyzed.
- 53.5% of patients received lipid-lowering therapy, but only 26% achieved cholesterol levels below 200 mg/dl in both treated and untreated groups.
- Lipid profiles were documented for a small percentage; LDL levels below 100 mg/dl or 130 mg/dl were rarely achieved, even in treated patients.
Conclusions:
- A significant proportion of patients undergoing multiple PTCAs receive inadequate treatment or monitoring for hypercholesterolemia.
- Aggressive invasive management (PTCA) does not guarantee adequate lipid management.
- There is a need for improved surveillance and treatment strategies for hypercholesterolemia in patients with established CAD.
Background:
Hypercholesterolemia is a known risk factor for coronary artery disease (CAD). Multiple studies have shown that its treatment will reduce the rate of progression of coronary atherosclerosis and lead to regression of the atherosclerotic process. Recent studies have also shown impact on mortality. Angioplasty (PTCA) is a well established revascularization procedure for many of these patients. In this study we investigated whether or not therapy for hypercholesterolemia in patients undergoing elective PTCA had been instituted and, if so, whether desirable cholesterol levels had been achieved.
Methods:
We reviewed the charts of 129 patients (pts) who were consecutively admitted for elective PTCA between September 1993 and August 1994. All pts. had at least one PTCA in the past and all of them had the diagnosis of hypercholesterolemia. The list was made using a computer search of all pts. meeting the previous two diagnoses. Pts on whom PTCA was performed in the setting of acute ischemic events were excluded as well as pts with no known history of hypercholesterolemia.
Results:
In 13 out of 129 pts., it was not possible to find cholesterol levels. The 116 pts in whom cholesterol levels were available were divided in two groups. Group I (54 pts.-46.5%) included pts. not being treated with any lipid lowering agent and group II (62 pts.-53.5%) included pts being treated with at least one of those drugs. Both groups were further subdivided into "A" and "B", depending on whether the PTCA was being performed because of a "new" lesion or because of "restenosis", respectively. Group IA had a total of 31 pts, IB 23 pts, IIA 29 pts and IIB, 33 pts. Group I pts had an average of 3.40 PTCA's and a mean cholesterol level of 227 mg/dl. Group II pts had an average number of PTCA's of 3.34 and a mean cholesterol level of 228 mg/dl. Group IA had an average number of PTCA's of 3.65 and a mean cholesterol level of 221 mg/dl; for group IIA these values were, respectively, 3.17 and 221 mg/dl. Group IB had an average number of procedures of 3.09 while for group IIB this number was 3.49; the mean cholesterol levels were, respectively, 235 mg/dl and 234 mg/dl. None of these differences is statistically significant. Group I had 14 pts (26%) with cholesterol levels below 200 mg/dl while group II had 16 pts. with cholesterol levels below 200 mg/dl (26%). In group I, 8 pts (14%) had lipid profiles documented. Only 1 pt. had an LDL level below 100 mg/dl and only 3 pts had an LDL level below 130 mg mg/dl. In group II, 15 pts (24%) had a lipid profile documented. Of these, no pt. had an LDL level below 100 mg/dl and only 4 pts had an LDL level below 130 mg/dl.
Conclusions:
A significant percentage of pts. undergoing multiple PTCA's are not being treated or monitored adequately for hypercholesterolemia despite aggressive invasive management.