Clinical research studyCholesterol Treatment and Changes in Guidelines in an Academic Medical Practice
Section snippets
Methods
SLUCare is the academic clinical practice of the School of Medicine at Saint Louis University, based in Saint Louis, Missouri. The Division of General Internal Medicine and Department of Family Medicine include approximately 115 physicians, resident trainees, and associated staff at 3 ambulatory care clinics that see an average of approximately 13,000 unique patients per year. A Primary Care Patient Data registry was created by extracting records from 27,225 patients (Family Medicine = 10,994,
Results
The number of eligible patients was 4536 (Figure 1), with an average age of 56.7 years (SD 9.1). Table 1 describes the demographic characteristics of the study population. There were more female patients (60%) than male. The racial distribution of eligible patients was appropriate for the area of St. Louis that SLUCare serves, with 53% white (Caucasian), 44% Black (African-American), and 3% other race. Approximately 10% of the cohort had atherosclerotic vascular disease, and 12% were actively
Discussion
In our evaluation of real-world cholesterol management in a large, academic group practice, we found that treatment would be affected considerably by the ACC/AHA guidelines on cholesterol reduction management. The 2013 ACC/AHA guidelines shifted away from an emphasis on LDL treatment targets as recommended by ATPIII guidelines to treatment based on calculated cardiovascular risk. Across all risk categories, the ACC/AHA treatment regimens will result in an increased prescribing of statins.
Over
Acknowledgment
We appreciate the support of the Departments of General Internal Medicine and Family Medicine at Saint Louis University.
References (24)
- et al.
2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults
J Am Coll Cardiol
(2014) - et al.
Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
J Am Coll Cardiol
(2004) - et al.
Statins: new American guidelines for prevention of cardiovascular disease
Lancet
(2013) - et al.
The influence of physicians' guideline compliance on patients' statin adherence: a retrospective cohort study
Am J Geriatr Pharmacother
(2005) - et al.
Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361,662 men
Lancet
(1986) - et al.
Deaths: preliminary data for 2010
Natl Vital Stat Rep
(2012) - et al.
Expert panel on detection, evaluation and treatment of high blood cholesterol in adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III)
JAMA
(2001) - et al.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Circulation
(2014) - et al.
Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials
Lancet
(2010) - et al.
Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations
JAMA
(2014)
National trends in statin use by coronary heart disease risk category
PLoS Med
Trends in statin use and low-density lipoprotein cholesterol levels among US adults: impact of the 2001 National Cholesterol Education Program guidelines
Ann Pharmacother
Cited by (19)
Effects of time-restricted feeding (16/8) combined with a low-sugar diet on the management of non-alcoholic fatty liver disease: A randomized controlled trial
2023, NutritionCitation Excerpt :Conversely, it must be noted that we did not examine specific subparticles of lipoproteins, which represents a feasible way of detecting their functionality and levels of atherogenicity [70,71]. Nonetheless, the traditional lipid profile is sufficient to at least draw clinical recommendation as endorsed by common guidelines [72,73]. Apart from lipid indices as prognostic markers of major cardiovascular events, the reduction we observed for hs-CRP (∼3.1 to ∼2 mg/L) reflects a transition of high risk for cardiovascular disease (>3 mg/L) to moderate risk (1 to 3 mg/L) in the intervention group [74].
Atherosclerosis and Autoimmunity
2017, Handbook of Systemic Autoimmune DiseasesCitation Excerpt :Indeed, the “altered-lipoprotein” hypothesis suggests that oxidized LDL (oxLDL) may be responsible for foam cells formation. So far, testing the blood level of LDL cholesterol is the best biomarker for AS (Schoen et al., 2015). LDL is the ultimate source of cholesterol, which accumulates in foam cells.
The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization?
2016, Health PolicyCitation Excerpt :As far as the threshold, some consider it to be “aggressive,” and point out that guidelines in other countries have higher thresholds, as for example the most recent ones in the U.K. and Australia, which are set at 10% over 10 years and 10–15% over 5 years respectively [11]. Estimates indicate that this aspect of the U.S. guidelines would broaden the use of statins for those between the ages of 40 and 75 by 25–30% [4,12,13]. In practical terms, it is estimated that the new guidelines would recommend statin therapy for nearly all men > 60, women > 69 years [7,14], and all African American men over the age of 65 with normal blood pressure and cholesterol levels [15].
Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women
2016, American Journal of CardiologyDeficits in allergy knowledge among physicians at academic medical centers
2015, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :As such, they might be less likely to remain current with allergy-specific literature or published recommendations. Even with the publication and disbursement of disease-specific practice management guidelines by specialty boards,21,22 evidence has shown that adoption of these guidelines by general practitioners is slow and poor.45–48 Needless to say, physicians in training who learn incorrect or out-of-date information from their attending physicians are likely to adopt the same practice.
Pharmacist Statin Prescribing Initiative in Diabetic Patients at an Internal Medicine Resident Clinic
2020, Journal of Pharmacy Practice
Funding: Supported with funds from the Department of Family Medicine and Division of General Internal Medicine, Saint Louis University School of Medicine.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript. Study concept and design was performed by MWS and FB Data collection and processing was performed by JS and JFS, data analysis was performed by MWS. The manuscript was drafted by MWS, with editing by FB, JS, and JFS, MS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.