Achieving National Cholesterol Education Program goals for low-density lipoprotein cholesterol in cardiac patients: importance of diet, exercise, weight control, and drug therapy. A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study The role of clinical pharmacist on lipid control in dyslipidemic patients in North of Jordan Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease. Impact of pharmacy counseling on compliance and effectiveness of combination lipid-lowering therapy in patients undergoing coronary artery revascularization: a randomized, controlled trial. Lipid-lowering medication for secondary prevention of coronary heart disease in a German outpatient population: the gap between treatment guidelines and real life treatment patterns. Lipid levels and use of lipid-lowering drugs for patients in pharmacist-managed lipid clinics versus usual care in 2 VA Medical Centers. Pharmacogenetic Predictors of Statin-Mediated Low-Density Lipoprotein Cholesterol Reduction and Dose Response Effect of niacin and atorvastatin on lipoprotein subclasses in patients with atherogenic dyslipidemia. Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study. Clinical impact of a pharmacist-physician co-managed programme on hyperlipidaemia management in Hong Kong. The effect of pharmacist intervention and patient education on lipid-lowering medication compliance and plasma cholesterol levels. Clinical predictors of plaque progression despite very low levels of low-density lipoprotein cholesterol. Maintenance of low-density lipoprotein goal with step-down pravastatin therapy. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting.
OBJECTIVE To determine how frequently the National Cholesterol Education Program ( NCEP ) goal of a low-density lipoprotein ( LDL ) cholesterol level of 100 mg/dL or less is achieved in clinical practice in patients with coronary artery disease and what fraction of patients can achieve this goal without drug therapy . DESIGN We examined the results of lipid management in 152 consecutive patients who had completed cardiac rehabilitation after an acute coronary event . Patients were r and omized to follow-up by specially trained nurses or by preventive cardiologists , and they were not receiving  lipid-lowering drugs at the start of the study . MATERIAL AND METHODS Patients were given aggressive diet and exercise recommendations and lipid-lowering drugs in accordance with NCEP guidelines . Follow-up was continued for a mean of 526 days after the first lipid assessment subsequent to the coronary event . Multiple logistic regression analysis was used to identify independent predictors of a final LDL cholesterol level of 100 mg/dL or less . RESULTS Of the study group , 39 % achieved the NCEP goal LDL cholesterol level of 100 mg/dL or less . Characteristics of the patients with LDL cholesterol levels of 100 mg/dL or less in comparison with those with LDL cholesterol levels of more than 100 mg/dL included a greater frequency of drug therapy ( 65 % versus 38 % ) , more rigorous dietary compliance , longer follow-up ( 586 + /- 317 days versus 493 + /- 264 days ) , more favorable weight change ( -0.3 + /- 4.9 kg versus + 1.7 + /- 5.0 kg ) , and more extensive weekly exercise ( 183 + /- 118 minutes versus 127 + /- 107 minutes ) . CONCLUSION The registered nurses managed the lipids of these patients as effectively as did the preventive cardiologists . Appropriate drug therapy was the most important factor in achieving an LDL cholesterol level of 100 mg/dL or less , but 35 % of patients attaining this NCEP goal were not receiving drug therapy . Exercise , dietary compliance , and weight loss were also important factors Background : Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia . Methods : We r and omly assigned clusters consisting of at least two physicians  and at least four pharmacists  to provide collaborative care or usual care . Under the collaborative care model , pharmacists counselled patients about their medications , requested laboratory tests , monitored the effectiveness and safety of medications and patients ’ adherence to therapy , and adjusted medication dosages . After 12 months of follow-up , we assessed changes in low-density lipoprotein ( LDL ) cholesterol ( the primary outcome ) , the proportion of patients reaching their target lipid levels and changes in other risk factors . Results : Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited , and a total of 51 physicians and 49 pharmacists were included in the final analyses . The collaborative care teams followed a total of 108 patients , and the usual care teams followed a total of 117 patients . At baseline , mean LDL cholesterol level was higher in the collaborative care group ( 3.5 v. 3.2 mmol/L , p = 0.05 ) . During the study , patients in the collaborative care group were less likely to receive high-potency statins  ( 11 % v. 40 % ) , had more visits with health care professionals and more laboratory tests , were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes . At 12 months , the crude incremental mean reduction in LDL cholesterol in the collaborative care group was −0.2 mmol/L ( 95 % confidence interval [ CI ] −0.3 to −0.1 ) , and the adjusted reduction was −0.05 ( 95 % CI −0.3 to 0.2 ) . The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 ( 95 % CI 0.95 to 1.26 ) , and the adjusted relative risk was 1.16 ( 95 % CI 1.01 to 1.34 ) . Interpretation : Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia . International St and ard R and omized Controlled Trial register no. IS RCT N66345533 Objective The purpose of this study is to investigate the effectiveness of introducing clinical pharmacy services in achieving goal lipid profile in dyslipidemia patients in North of Jordan . Setting the study was carried out in a primary care facility in North of Jordan . Methods : One hundred fifty two dyslipidemia patients were r and omized into intervention and control groups and followed for 6 months period . Intervention group patients were followed intensively by a clinical pharmacist who worked closely with physicians in controlling lipid profiles according to the third edition of recommendations by The National Cholesterol Education Program Adult Treatment Panel , control group patients were provided with st and ard medical care . Main outcome measure percent of patients at their low density lipoprotein cholesterol target in the intervention group compared to percent of patients at their low density lipoprotein cholesterol target in the control group by the end of the study . Results : One hundred twenty five patients completed the study duration . After 6 months , 94.5 % of intervention group patients and 71.2 % of control group patients reached their goal low density lipoprotein cholesterol levels ( P value < 0.001 , Pearson Chi-Square test ) compared to 24.7 and 28.8 % respectively at baseline . Majority of pharmacist recommendations ( 90.4 % ) were followed by physicians and overall lipid lowering agents use was increased to 91.8 % in intervention group patients and 86.5 % in control group patients compared to 69.9 and 78.8 % respectively at baseline . Conclusion : Implementing clinical pharmacy services in Jordan has improved the lipid profiles of dyslipidemic patients ABSTRACT BACKGROUND Many individuals at higher risk for cardiovascular disease ( CVD ) do not receive recommended treatments . Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness . OBJECTIVE AND DESIGN To perform a 9-month cluster-r and omized trial , comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care . PARTICIPANTS Patients of participating physicians with a Framingham Risk Score of at least 5 % , low-density lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment , and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis .INTERVENTION Patients of physicians r and omized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin ( and controlling hypertension or quitting smoking when relevant).MAIN MEASURES The primary outcome was occurrence of a LDL-cholesterol level , repeated in routine practice , that was at least 30 mg/dl lower than prior . A secondary outcome was lipid-lowering drug prescribing . Clinical trials.gov identifier : NCT01286311.KEY RESULTS Fourteen physicians with 218 patients were r and omized to intervention , and 15 physicians with 217 patients to control . The mean patient age was 60.7 years and 77 % were male . There was no difference in the primary outcome ( 11.0 % vs. 11.1 % , OR 0.99 , 95 % CI 0.56–1.74 , P = 0.96 ) , but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication ( 11.9 % , vs. 6.0 % , OR 2.13 , 95 % CI 1.05–4.32 , p = 0.038 ) . In post hoc analysis with extended follow-up to 18 months , the primary outcome occurred more often in the intervention group ( 22.5 % vs. 16.1 % , OR 1.59 , 95 % CI 1.05–2.41 , P = 0.029 ) . CONCLUSIONS In this effectiveness trial , individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions , but we observed no difference in proportions lowering LDL-cholesterol after 9 months . With longer follow-up , the intervention ’s effect on LDL-cholesterol levels was apparent BACKGROUND Firm evidence exists for reduction in mortality and morbidity by lipid-lowering therapy in patients with coronary artery disease ( CAD ) , yet a significant proportion remain untreated . This prospect i ve study determined the effectiveness of a planned strategy of management using a cardiac rehabilitation nurse in achieving ( 1 ) lower 6-month low-density lipoprotein ( LDL ) levels and ( 2 ) a higher proportion of patients on pharmacologic therapy .  METHODS A cardiac rehabilitation nurse arranged for the lipid profiles and initiated pharmacologic therapy as soon as possible after the diagnosis of CAD . In phase 1 , this  planned- strategy intervention group ( n = 80 ) was compared with the usual-care control group ( n = 189 ) , where the management was left at the discretion of the attending cardiologist with the assignment to the 2 groups based on the weekly on-call rotations of the attending cardiologists in a nonr and omized manner . In phase 2 of the study all patients ( n = 366 ) were enrolled in the planned strategy of management . RESULTS There were no significant differences in the baseline lipid values between the control and intervention groups . The 6-month cholesterol and LDL values and the percentage of patients on lipid-lowering medications were significantly better in the intervention group ( P = .01 ) . In phase 2 the results obtained in the intervention group were duplicated in a much larger group of consecutive patients . The 6-month ( millimoles per liter ) results in the control , intervention , and phase 2 groups ( respectively ) were cholesterol 4.92 + /- 0.06 , 4.60 + /- 0.07 , 4.30 + /- 0.05 ; low-density lipoprotein 2.91 + /- 0.06 , 2.68 + /- 0.07 , 2.4 + /- 0.06 ; high-density lipoprotein 1.18 + /- 0.07 , 1.12 + /- 0.09 , 1.10 + /- 0.01 ; triglycerides 1.89 + /- 0.12 , 1.78 + /- 0.09 , 1.70 + /- 0.05 ; and on medications 49 % , 83 % , and 84 % . CONCLUSION A planned strategy of management with use of early pharmacologic therapy with a cardiac rehabilitation nurse assigned to obtain and follow lipid profiles and initiate therapy is more effective in controlling dyslipidemia than leaving the management to the cardiologist This r and omized , controlled trial evaluated the impact of personalized follow-up on compliance rates in high-risk patients receiving combination lipid-lowering therapy over 2 years . A r and om sample of 30 patients 7 - 30 days after cardiac surgery had baseline fasting low-density lipoprotein levels higher than 130 mg/dl . All patients received lovastatin 20 mg/day and colestipol 5 g twice/day . Weekly telephone contact was made with each patient for 12 weeks . Short- and long-term compliance was assessed by pill and packet counts and refill records . Compliance and lipid profile results were significantly better in the intervention group ( p<0.05 ) up to 2 years after the start of therapy than in the control group for all parameters except high-density lipoprotein . However , this effect was not apparent during the first 12 weeks of therapy . Short-term telephone follow-up favorably affected compliance and lipid profile results up to 2 years after start of therapy BACKGROUND Few published data in particular from the United States indicate that the implementation of guidelines for prevention of coronary heart disease ( CHD ) is far from optimal . The objective of our study was to identify the type and prevalence of lipid-lowering medications in a German outpatient CHD population and to examine the impact of applied treatment regimens on serum lipid levels . METHODS Retrospective analysis of the washout phase of 2,856 CHD patients requiring lipid-lowering medication .  Data are derived from a multicenter , r and omized , open-label , parallel group clinical trial comparing the safety and efficacy of atorvastatin versus simvastatin in 591 centers in Germany . Medical history , physical examination , and serum lipid levels were obtained at the beginning of the washout phase ( Week -6 ) and at the end of the washout phase ( Week -1 , i.e. , 5 weeks after the discontinuation of all prior lipid-lowering medications ) . The data at Week -6 represented the lipid levels under real life conditions . The difference from the data at Week -1 reflected the therapeutic effects achieved by the previous lipid-lowering treatment . RESULTS The mean low-density lipoprotein cholesterol ( LDL-C ) level at Week -6 was 173.4 + /- 42.5 mg/dl . Only 176 ( 6.2 % ) of 2,856 CHD patients were found to meet the target LDL-C level of < 115 mg/dl at Week -6 , only 76 ( 2.7 % ) patients had LDL-C levels < 100 mg/dl , and 363 ( 12.7 % ) patients had LDL-C levels < 130 mg/dl . After discontinuation of all prior lipid-lowering medications , mean LDL-C increased to 187.2 + /- 44.0 mg . This means that only a marginal 7.4 % reduction in LDL-C level was achieved under real life treatment conditions . This limited LDL-C reduction was due mainly to the low prevalence of lipid-lowering treatment ( 65.5 % of patients did not receive any medication at all ) and inadequate dosing . With respect to the effect on LDL-C and total cholesterol , statins alone were superior to fibrates . CONCLUSION The study shows that there is a wide gap between treatment guidelines and real life treatment patterns in Germany . Awareness of the risks of high cholesterol levels has to be increased among both patients and physicians . Available treatment guidelines should be better implemented OBJECTIVE The objective of this study was to assess the effectiveness of pharmacist- managed dyslipidemia clinics at 2 Veterans Affairs medical centers since the release of the 2001 National Cholesterol Education Panel Adult Treatment Panel III ( NCEP ATP III ) guideline compared with the usual care ( UC ) provided by other health care professionals in the same setting . METHODS Analysis was performed through retrospective chart review of patients with a diagnosis of dyslipidemia who received care in either the Amarillo or Lubbock , Texas , pharmacist-managed lipid clinics ( LCs ) or UC from a primary care physician . Data from medical charts were abstract ed for date s of service from July 2001 to December 2003 for 115 patients selected r and omly from LC rolls matched with 115 patients with a diagnosis of dyslipidemia selected r and omly from UC . All patients had to have had at least 3 visits with the LC or 3 visits in UC with a billing code of dyslipidemia ; they were followed for at least 6 months after an initial visit in July 2001 or thereafter and were enrolled in the VA health care system for at least 1 year . Baseline lipid values were available for LC but not UC patients . Cholesterol target goals were determined according to NCEP ATP III guideline . RESULTS After an average of 21.6 months of follow-up , the proportion of patients in the LC group that attained goal level increased from 45.2 % at baseline to 82.6 % for total cholesterol ( TC ) and from 36.5 % at baseline to 64.3 % for lowdensity lipoprotein cholesterol ( LDL-C [ P < 0.001 for both comparisons ] ) . There was an average 24.5 mg/dL absolute reduction ( relative reduction , 19.4 % ) in LDL-C along with significant improvements in the other lipid levels ( P < 0.001 for TC and LDL-C , P = 0.007 for triglycerides [ TGs ] ) with the exception of highdensity lipoprotein cholesterol ( HDL-C ) , which declined from 40.0 mg/dL to 36.3 mg/dL ( P < 0.001 ) . A total of 50 patients ( 43.5 % ) were on lipid-lowering pharmacotherapy at baseline versus 108 patients ( 93.9 % ) at follow-up . Compared with UC , LC patients were more likely to have achieved goal LDL-C ( 64.3 % vs. 15.7 % for UC , P < 0.001 ) and TC ( 82.6 % vs. 40.9 % , P < 0.001 ) , but there was no difference in the proportion of patients at TG goal for LC ( 65.2 % ) compared with UC ( 52.2 % , P = 0.061 ) or at HDL-C goal ( 23.5 % for LC vs. 33.0 % for UC , P = 0.143 ) . A higher proportion of LC patients ( 93.9 % ) used  lipid-lowering agents  compared with UC patients ( 24.3 % , P < 0.001 ) . Sub analysis of patients on a lipid-lowering agent found that a significantly higher proportion ( 85.2 % ) in the LC group were at goal total cholesterol compared with 60.7 % for UC ( P = 0.012 ) and at goal LDL-C ( 66.7 % for LC vs. 39.3 % for UC , P = 0.016 ) . However , a lower proportion were at goal HDL-C for LC ( 21.3 % ) versus 42.9 % for UC ( P = 0.043 ) . Overall , only 11 LC patients ( 9.6 % ) attained goal levels for all 4 serum lipid values by the end of follow-up versus 2 UC patients ( 1.7 % , P = 0.019 ) . CONCLUSIONS Nearly two thirds of patients diagnosed with dyslipidemia and enrolled in a pharmacist-managed LC had LDL-C levels at or below NCEP ATP III target goal compared with 16 % of dyslipidemia patients who received UC from their primary care provider . The pharmacist-managed LC patients were also twice as likely ( 83 vs. 41 % ) to have attained the TC target goal , but there was no difference between the 2 groups in the proportion of patients who attained either TG or HDL-C target goals . Only 9.6 % of LC patients were at goal for all 4 individual lipid measures at the end of follow-up Background —There is interindividual variation in low-density lipoprotein cholesterol ( LDLc )  lowering by statins and limited study into the genetic associations of the dose dependant LDLc lowering by statins . Methods and Results —Five hundred nine patients with hyperlipidemia were r and omly assigned atorvastatin 10 mg , simvastatin 20 mg , or pravastatin 10 mg ( low-dose phase ) followed by 80 mg , 80 mg , and 40 mg ( high-dose phase ) , respectively . Thirty-one genes in statin , cholesterol , and lipoprotein metabolism were sequenced and 489 single nucleotide polymorphisms with minor allele frequencies > 2 % were tested for associations with percentage LDLc lowering at low doses using multivariable adjusted general linear regression . Significant associations from the analysis at low dose were then repeated at high-dose statins . At low doses , only 1 single nucleotide polymorphism met our experiment-wide significance level , ABCA1 rs12003906 . Twenty-six subjects carried the minor allele of rs12003906 , which was associated with an attenuated LDLc reduction ( LDLc reduction in carriers versus noncarriers −24.1±2.6 % versus −32.2±1.5 % ; P=0.0001 ) . In addition , we replicated the association with the APOE ϵ3 allele and a reduced LDLc reduction . At high doses , carriers of the minor allele of ABCA1 rs12003906 and the APOE ϵ3 allele improved their LDLc reduction but continued to have a diminished LDLc reduction compared with noncarriers ( −30.5±4.0 % versus −42.0±2.4 % ; P=0.005 ) and ( −38.5±1.9 % versus −45.3±2.8 % ; P=0.009 ) , respectively . Conclusions —An intronic single nucleotide polymorphism in ABCA1 and the APOE ϵ3 allele are associated with reduced LDLc lowering by statins and identify individuals who may be resistant to maximal LDLc lowering by statins This study was conducted to determine the efficacy of atorvastatin and niacin on lipoprotein subfractions in patients with atherogenic dyslipidemia . This was a multicenter , r and omized , open-label , parallel- design study of patients with total cholesterol > 200 mg/dl , triglycerides between 200 and 800 mg/dl , and apolipoprotein B > 110 mg/dl . Patients were r and omly assigned to atorvastatin 10 mg or immediate release niacin 3,000 mg daily for 12 weeks following a low-fat diet stabilization period . Lipoprotein subclasses were measured by nuclear magnetic resonance spectroscopy . Atorvastatin and niacin both significantly reduced the concentrations of very low-density lipoprotein ( VLDL ) particles ( -31 % and -29 % , respectively ) and small low-density lipoprotein ( LDL ) particles ( -44 % and -35 % , respectively ) . Niacin increased the concentration of large LDL ( + 75 % ) . Atrovastatin reduced the number of LDL particles more than niacin ( 31 % vs 14 % ) . In patients with atherogenic dyslipidemia , both drugs had important effects on lipoprotein subfractions , which contributed to a reduction in coronary heart disease risk . The drugs equally reduced VLDL subclass levels . Niacin shifted the LDL subclass distribution toward the larger particles , more effectively converted patients from LDL phenotype B to phenotype A , and increased levels of the larger and perhaps more cardioprotective high-density lipoprotein particles . In contrast , atorvastatin preferentially lowered the concentration of small LDL particles without increasing levels of large LDL , and more effectively , reduced LDL particle numbers .  Atorvastatin had a preferred LDL effect , whereas niacin had a preferred high-density lipoprotein effect BACKGROUND Hypercholesterolemia control status is lacking throughout the western world . OBJECTIVES To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education Program for coronary artery disease prevention ; and to study the effects of brief educational sessions on the adherence of physicians with the guidelines . METHODS We included consecutive IHD patients admitted to four central hospitals in Israel between 1998 and 2000 . The study was conducted in two phases . In phase 1 , we review ed discharge letters to document treatment recommendations given to each patient . In phase 2 we educated the practitioners by review ing the Israeli medical societies and the NCEP guidelines and the quality of their recommendations in phase 1 , after which we reevaluated the discharge letters . RESULTS The study included 2,994 patients : 627 in phase 1 and 2,367 in phase 2 . Of the patients who needed cholesterol-lowering according to their low density lipoprotein levels  , 37.4 % were not prescribed such drugs at discharge ( under-treatment group ) . This proportion was reduced by education to 26.6 % ( P < 0.001 ) in phase 2 . Of the treated patients , 65.6 % did not reach the target LDL goal in phase 1 ( under-dosage group ) as compared to 60.2 % in phase 2 ( P = 0.23 ) . In phase 2 there was an increase in the percent of patients reaching LDL levels < 130 mg/day ( 69.3 % vs. 63.8 % of patients prescribed medication , P = 0.01 ) , but the percent of patients reaching ' LDL levels < 100 was not different in phase 2 after adjusting for age and gender ( the odds ratio for reaching target LDL was 1.16 , with 95 % confidence interval of 0.95 - 1.43 ) . CONCLUSIONS Physician recommendations to IHD patients discharged from hospital were suboptimal . We documented a high proportion of under-treated and under-dosaged patients . Brief educational sessions have a beneficial effect on the usage of statins ; however , additional effort in guideline implementations is needed OBJECTIVE The study aim ed to investigate the clinical impact of pharmacist-physician co-managed programme on the management of  hyperlipidaemia . METHODS The study was a prospect i ve r and omized controlled trial . Adult patients were selected if : ( i ) they were taking one or more lipid-lowering agents with a valid lipid panel before their next follow up ; ( ii ) had a baseline lipid profile within the previous 6 months ; ( iii ) their lipid panel did not reach the targeted low-density lipoprotein-cholesterol ( LDL-C ) goal based on the National Cholesterol Education Programme Adult Treatment Panel III . Pharmacists interviewed patients in the intervention group for 15 - 30 min to provide consultation on the drug regimen and lifestyle modifications . A telephone follow-up every 4 weeks and a follow-up interview on the date of the physician visit were scheduled . Patients in the control group received routine conventional care . The primary outcome measurement was the change in lipid panel between baseline and at the end of study . RESULTS One hundred and eighteen patients were recruited to the study [ 58 patients in intervention group ( mean age 63 + /- 10 years old ) and 60 in control group ( mean age 61 + /- 12 years old ) ] . Starting with similar baseline levels , the end of study LDL-C and total cholesterol levels for the intervention and control groups were LDL-C : 2.80 + /- 0.89 mmol/L and total cholesterol 4.75 + /- 1.08 mmol/L vs. LDL-C : 3.24 + /- 0.78 mmol/L and total cholesterol 5.18 + /- 0.93 mmol/L , respectively . The differences were statistically significant ( P < 0.0015 ) . CONCLUSION The study showed that a pharmacist-physician co-managed programme for hyperlipidaemic patient was effective in getting more patients to reach their target lipid levels BACKGROUND Dyslipidemias are a modifiable risk factor for coronary heart disease . The benefits of cholesterol reduction drug therapies are limited by poor patient compliance with drug regimens . OBJECTIVES To determine the impact of a community pharmacist pilot disease-management program on patient compliance with lipid-lowering drug therapy and on serum cholesterol levels . METHODS One hundred forty-nine patients who were nonadherent to prescribed hypolipidemic drug regimens were recruited for this six-month prospect i ve study . Each subject served as their own control . Pharmacists educated these patients on lipid disorders , the benefit of medication compliance and lifestyle modifications that reduce the risk for coronary heart disease . Pharmacists followed up participants by telephone at two-month intervals . Drug renewal rates were monitored throughout the study and plasma lipid levels were measured at study outset and study end . RESULTS Pharmacist intervention and patient-education programs significantly increased medication compliance , as shown by a 15.3 % increase ( P<0.05 ) in the number of compliant patients and an 11 day ( P<0.001 ) reduction in the average number of days to prescription renewal . Concurrently , levels of total cholesterol , triglycerides and low-density lipoprotein ( LDL ) cholesterol , were reduced by 6 % , 16.2 % , and 8.5 % ( P<0.001 , 0.01 , 0.01 ) , respectively . High density lipoprotein ( HDL ) cholesterol remained relatively unchanged ( + 0.7 % ) so that the LDL to HDL ratio was improved by 17.2 % overall ( P<0.01 ) . Almost all of the patients ( 99.2 % ) were satisfied with the program and expressed a willingness to pay an average $ 34.50 per 30 min consultation for the pharmacist services offered . CONCLUSION Pharmacists can contribute significantly to disease management of dyslipidemic individuals OBJECTIVES The purpose of this study was to characterize the determinants of plaque progression despite achieving very low levels of low-density lipoprotein cholesterol ( LDL-C ) . BACKGROUND Despite achieving very low levels of LDL-C , many patients continue to demonstrate disease progression and have clinical events . METHODS A total of 3,437 patients with coronary artery disease underwent serial intravascular ultrasound examination in 7 clinical trials . Patients who achieved an on-treatment LDL-C level of < or=70 mg/dl ( n = 951 ) were stratified as progressors ( n = 200 ) and nonprogressors ( n = 751 ) and compared . RESULTS Despite achieving LDL-C < or=70 mg/dl , > 20 % of patients continued to progress . There were no demographic differences between groups . Progressors demonstrated higher baseline levels of glucose ( 117.1 + /- 42.5 mg/dl vs. 112.1 + /- 40.0 mg/dl , p = 0.02 ) , triglycerides ( 157.5 mg/dl vs. 133.0 mg/dl , p = 0.004 ) , and a smaller decrease of apolipoprotein B ( -25.1 + /- 3.4 mg/dl vs. -27.4 + /- 3.35 mg/dl , p = 0.01 ) at follow-up . Multivariable analysis revealed that independently associated risk factors of progression in patients with LDL-C < or=70 mg/dl included baseline percent atheroma volume ( p = 0.001 ) , presence of diabetes mellitus ( p = 0.02 ) , increase in systolic blood pressure ( p = 0.001 ) , less increase in high-density lipoprotein cholesterol ( p = 0.01 ) , and a smaller decrease in apolipoprotein B levels ( p = 0.001 ) , but not changes in C-reactive protein ( p = 0.78 ) or LDL-C ( p = 0.84 ) . CONCLUSIONS Residual risk factors are associated with the likelihood of disease progression in patients who achieve very low LDL-C levels . In addition , the association between apolipoprotein B and atheroma progression highlights the potential importance of LDL particle concentration in patients with optimal LDL-C control . This finding highlights the need for intensive modification of global risk in patients with coronary artery disease STUDY OBJECTIVE To determine whether patients who had achieved their National Cholesterol Education Program (NCEP)-derived goals for low-density lipoprotein ( LDL ) cholesterol with pravastatin  would benefit from step-down therapy . DESIGN Prospect i ve , r and omized , open-label study SETTING Kansas City Veterans Affairs Medical Center . PATIENTS One hundred four men who were taking pravastatin once/day and had maintained their NCEP-defined LDL goal for at least 3 months . INTERVENTION Fifty-three patients were r and omized to group 1 , for which the dosing frequency was changed from daily to every other day , and 51 patients were r and omized to group 2 , for which the daily dose was halved . MEASUREMENTS AND MAIN RESULTS Fasting lipid profiles and hepatic transaminase levels were analyzed at baseline , 2 months , and 4 months . Lifestyle , concomitant drug therapy , adverse events , weight , and compliance were noted at baseline and month 4 . Thirty-one patients ( 58 % ) from group 1 and 22 patients ( 43 % ) from group 2 did not remain at their LDL goal after step-down pravastatin therapy Mean LDL at study end was 113 mg/dl for group 1 and 104 mg/dl for group 2 ( p=0.04 ) . CONCLUSION More than half ( 51 % ) of the patients enrolled did not remain at their LDL goal with step-down pravastatin therapy Therefore , we do not recommend a step-down approach for patients who have achieved their LDL goals . If a clinician decides , however , to attempt dosage reduction , the preferred regimen appears to be to halve the current dose once/day ( vs administering the current dose every other day ) . A fasting lipid profile should be evaluated at 2 months and 4 months after step-down therapy begins to ensure that desired outcomes are achieved OBJECTIVES To identify patients at risk for coronary artery disease ( CAD ) through a search of a community pharmacy 's prescription data base , to screen and identify patients with elevated cholesterol and at risk for CAD , to enroll patients in a pharmacist-directed lipid management program , and to evaluate selected clinical and humanistic outcomes . DESIGN R and omized , pretest-posttest control groups . SETTING Independent community pharmacy in a suburban metropolitan area . PATIENTS 51 patients who were not at National Cholesterol Education Program low-density lipoprotein cholesterol ( LDL-C ) or defined triglyceride goals and who met inclusion criteria . INTERVENTION Pharmacist-directed lipid management program . MAIN OUTCOME MEASURES Clinical outcome measures included total cholesterol , LDL-C , high-density lipoprotein cholesterol ( HDL-C ) , and triglyceride levels ; achievement of LDL-C goal ; and risk factor prediction scores . Humanistic outcome measures included patient satisfaction with pharmaceutical care and patient knowledge of hyperlipidemia . RESULTS LDL-C was decreased in the pharmacist intervention group ( n = 25 ) , compared with an increase in the control group at study end . HDL-C levels increased and triglyceride levels decreased in both groups . Of treatment group patients , 32 % achieved their cholesterol goals , compared with 15 % of control group patients . Risk factor prediction scores improved in the treatment group and worsened in the control group . The treatment group 's hyperlipidemia knowledge scores improved significantly from pretest to posttest . Both treatment and control group patient satisfaction scores for the pharmacist investigator were favorable at study end . CONCLUSION Both treatment and control patients benefited from participating in this study . Patients enrolled in the lipid management program made greater improvements in their knowledge of hyperlipidemia , risk factor scores , and cholesterol levels BACKGROUND Pharmacists have been shown to positively impact the outcomes of care for treatment of many different kinds of disease states . In particular , pharmacist-run lipid clinics have enjoyed varying degrees of success , depending on the outcome assessed . At our hospital , when a patient is transferred to the pharmacist-coordinated lipid clinic , the primary care pharmacist is responsible for ordering and interpreting labs and prescribing and monitoring lipid-altering therapy . OBJECTIVE This study was design ed to assess if there is a statistically significant difference between the magnitude of serum cholesterol reduction for patients receiving lipid-altering pharmacotherapy  when clinical ly trained pharmacists are actively prescribing and adjusting the drug therapy compared to other health care practitioners ( usual care ) . METHODS Patient records from the hospital computer data bases were retrospectively and r and omly selected for analysis . Following evaluation for inclusion s and exclusions , 41 patient records remained for statistical analysis for the cohort group , and 47 records remained from the group of patients managed by a clinical pharmacist . RESULTS Management of dyslipidemia by a clinical pharmacist was associated with a significant reduction in overall mean low-density lipoprotein ( LDL , 18.5 % ) compared to the cohort that did not have a clinical pharmacist as the primary manager of dyslipidemia ( 6.5 % , P=0.049 ) . This suggests improved clinical outcomes , defined as greater LDL reduction , when clinical pharmacists participate in lipid management , including drug prescribing . The magnitude reduction in LDL was found to be related to the number of clinical pharmacy visits ( 11.4 % for 1 visit , 23.2 % for 2 visits , and 23.7 % for > 3 visits ) , compared to the usual care group ( -11.0 % , 18.0 % , and 7.4 % ; statistically significant , P=0.038 , for > 3 visits only ) . These results occurred even though the group of dyslipidemic patients managed primarily by a clinical pharmacist contained a statistically greater number of patients with 2 or more risk factors and high-density lipoprotein ( HDL ) levels less than 40 mg/dL. CONCLUSION Interdisciplinary medical teams that include clinical pharmacists who are actively prescribing and adjusting lipid drug therapy may achieve greater reductions in LDL for patients who have been assessed with multiple risk factors compared to patients managed without clinical pharmacists . Active participation by clinical pharmacists in lipid management for patients with elevated LDL result ed in improved treatment success as measured by the magnitude reduction in LDL . The reduction in LDL was between 5 % and 22 % per visit greater for patients being treated by clinical pharmacists versus usual care , even in a patient population with more risk factors . These intermediate outcomes may translate into long-term outcomes in fewer cardiovascular events , improved quality of life for patients with dyslipidemia , and lower costs associated with sequelae of dyslipidemias
Conclusions Study -level data from this systemic review establish that different lipid lowering agents can lead to discordance between LDL-P and LDL-C , therefore , basing LDL-lowering therapy only on the achievement of cholesterol goals may result in a treatment gap .
Therefore , the use of LDL-P for monitoring lipid-lowering therapy , particularly for statins , can provide a more accurate assessment of residual cardiovascular risk
Purpose This systematic review was performed to summarize published experience using low density lipoprotein particle number ( LDL-P ) to monitor the efficacy of  lipid-lowering pharmacotherapies .