Achieving National Cholesterol Education Program Goals for Low-Density Lipoprotein Cholesterol in Cardiac Patients: Importance of Diet, Exercise, Weight Control, and Drug Therapy

Abstract

Achieving National Cholesterol Education Program Goals for Low-Density Lipoprotein Cholesterol in Cardiac Patients: Importance of Diet, Exercise, Weight Control, and Drug TherapyAllison TG, Squires RW, Johnson BD, Gau GT Mayo Clin Proc 1999;74:466-473 Background. The National Cholesterol Education Program (NCEP) guidelines recommend a low-density lipoprotein cholesterol (LDL) of ≤ 100 mg/dl in patients with coronary artery disease. Data on the attainment of these goals in clinical practice are limited. Methods. Consecutive patients who completed cardiac rehabilitation and were not on lipid-lowering drug therapy (LLD) were randomized to follow-up care with nurse lipid specialists (RN) or preventive cardiologists (UC). All patients received diet and exercise recommendations and were treated with LLD in accordance with NCEP guidelines. Results. The baseline LDL level in all 152 patients was 130 ± 29 mg/dl and did not differ between the groups. After a mean of 526 days of follow-up, 39% of all the patients had an LDL level ≤ 100 mg/dl and 35% of these patients were not receiving LLD therapy. Independent predictors of a final LDL level ≤ 100 mg/dl included LLD therapy (P < 0.001), baseline LDL level (P < 0.001), and amount of exercise in minutes/week (P < 0.05). There was no difference between the RN and UC groups in the percentage of patients reaching the target LDL levels. Conclusion. The authors conclude that nurses manage lipids as effectively as preventive cardiologists and that LLD therapy is the most important factor in achieving the target LDL level. Comments. The results of this study indicate modest success in attainment of NCEP goals within an academic preventive cardiology setting. Reasons for lack of attainment of these goals in the majority of patients and ways to improve compliance deserve further study.