Abstract P268: Telephone Counseling to Activate Peripheral Arterial Disease Patients Toward Improved Low Density Lipoprotein Cholesterol Levels: A Randomized Controlled Clinical Trial

Abstract

BACKGROUND: Patients with lower extremity peripheral arterial disease (PAD) have high rates of cardiovascular events but are less likely to achieve ideal low density lipoprotein cholesterol (LDL-C) levels than coronary artery disease patients. We determined whether a telephone counseling intervention, designed to activate PAD patients to request more intensive LDL-C lowering therapy from their physician, can help PAD patients achieve lower LDL-C levels compared to two control groups. METHODS: Three hundred fifty-five participants with PAD and baseline LDL-C ≥ 70 mg/dl were randomized to one of three parallel arms: telephone counseling intervention, attention control condition, and usual care. The primary outcome was change in LDL-C level at twelve- month follow-up. The secondary outcome was the percent of PAD participants with an LDL-C < 100 mg/dl at 12 month follow-up. The intervention consisted of eight patient-centered telephone counseling calls that encouraged PAD participants to request more intensive lipid-lowering therapy from their physician. The attention control group consisted of eight telephone calls providing knowledge about PAD. The usual care group participated in baseline and follow-up testing only. RESULTS: At 12-month follow-up, the telephone counseling intervention was associated with lower LDL-C levels as compared to attention control (-18.4 mg/dl vs. -6.8 mg/dl, p= 0.010) but not as compared to usual care (-18.4 mg/dl vs. -11.1 mg/dl, p= 0.208). Both attention control and the usual care condition were less likely to achieve an LDL-C < 100 mg/dl, compared to the intervention (odds ratio = 0.34, 95% Confidence Interval (CI) = 0.17-0.69, p=0.003 and odds ratio = 0.42, 95% CI = 0.20-0.86, p=0.018, respectively). Participants in the intervention were more likely to start a new statin medication than the attention control arm (18.6% vs. 5.5%, p=0.008) and usual care arm (18.6% vs. 5.5%, P=0.005). CONCLUSION: Among patients with PAD, a telephone counseling intervention designed to activate patients to request more intensive LDL-C lowering therapy from their physician resulted in lower LDL-C levels and higher rates of initiating cholesterol-lowering drugs, compared to control groups. 1