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Journal of Clinical Lipidology, Vol 1, No 2, May 2007
not reached goal levels. Furthermore, 40% of men and 24% of women who believed that they had a normal blood pressure were found to have either an elevated systolic or diastolic blood pressure.
Sex
Age TC
Men 28% 45 Women 72% 46
Non10-year HDL TC⬎200 HDL⬎160 risk
188 42 189 57
34% 35%
30% 17%
7% 3%
Framingham Risk Scores and % with abnormal cholesterol
Conclusions: In this retrospective review we concluded that a significant percentage of persons were identified as having hypertension or abnormal serum cholesterol levels but were completely unaware that they had these cardiovascular risk factors. We conclude that persons having significant risk factors for cardiovascular disease may be unaware of their presence. Thus, community programs to appraise cardiovascular risk may be useful to identify and educate individuals with potentially high cardiovascular risk factors. An ongoing study is being conducted to determine if subjects will take action on this information. 112 Effects of Lipid Apheresis on Ambulatory-measured Blood Pressure David B. Romerill, PharmD, Craig D. Williams, Mark A. Deeg, (Houston, TX) Synopsis: LDL apheresis reduces circulating LDL concentrations 40 –50% without removing plasma volume. Reductions in LDL by apheresis have been shown to improve endothelial function but effects on systemic blood pressure and the time course of any effects are not known. Purpose: Determine if LDL apheresis results in a significant reduction in mean arterial blood pressure measured by ambulatory blood pressure monitoring. Methods: 24-hour ambulatory blood pressure monitoring was used to test 6 patients who were undergoing LDL apheresis. Testing was performed 1 day prior to apheresis, 1 day after apheresis and at 1 week in between sessions. All patients were undergoing apheresis every 2 weeks. Blood pressure readings were obtained during testing every 20 minutes during waking hours and every 30 minutes during overnight periods. Pair-wise comparisons were performed to look for differences in systolic, diastolic, mean arterial (MAP) and pulse pressures. Results: Apheresis reduced LDL cholesterol by an average of 45% (range 37–52%). Systolic blood pressure was reduced by 3.3 mmHg on the day after apheresis compared to the day before (mean 125.7 mmHg compared to 122.4 mmHg, p⫽0.007). MAP was reduced by 2.5 mmHg (p ⫽ 0.01). Diastolic pressure and pulse pressure were non-significantly reduced by 1.4 mmHg and 1.9 mmHg (p ⫽ 0.11
and 0.06 respectively). Both systolic pressure and MAP had returned to baseline after 1 week. Conclusions: LDL apheresis reduces both systolic pressure and MAP. These reductions are sustained for less than 1 week. 113 Medication Evaluation in Diabetes to Optimize Statin Therapy (MED-OPS) Sheena Varghese, Maura Brown, Michelle Shaffer, Nicole T. Ansani, (Houston, TX) Synopsis: Diabetes is a risk factor equivalent for coronary heart disease and imposes a significant risk for cardiovascular (CV) morbidity/mortality. National guidelines recommend statin therapy for all adult diabetics; and a goal LDL cholesterol of less than 100mg/dL for diabetes patients. Despite evidence-based guidelines, cholesterol management is not optimal. Quality improvement (QI) efforts should include an analysis of prescribing patterns and goal attainment to provide improvements in evidence-based prescribing. Purpose: The purpose of this QI project was to quantify cholesterol management prescribing trends and goal attainment in diabetic patients. Methods: Fifteen primary care practices participated in a retrospective chart review; 30 –50 patient charts were randomly selected/physician office. Adult patients (18 – 89 years) with type 2 diabetes who visited their primary care physician within the past year and had a cholesterol panel within the past 2 years were included. Data was recorded using HIPAA-compliant data collection records. Outcomes included: demographics (age, gender, CV risk criteria [hypertension, smoking, retinopathy, macro/microalbuminuria], CV past medical history, and hypertension and diabetic medication use), use of statin therapy, and lipid profile. The primary outcomes were percent of diabetic patients on statin therapy and subsequent cholesterol goal attainment (per NCEP ATP III guidelines). Secondary outcomes included correlations between demographics and statin use. Results: Five-hundred and sixty-eight patients were included into the analysis; average age was 67 ⫹ 13 years and 51% of patients were female. Ninety-one percent of patients had at least 1 CV risk factor and 71% were categorized as primary prevention candidates for statin therapy. Results demonstrate that 69% (396) of all diabetics received statin therapy; 66% and 76% of primary and secondary prevention candidates, respectively. Cholesterol goal attainment (LDL ⬍100) was achieved in 63% (358) of all patients, 60% of primary and 71% of secondary prevention candidates. LDL goal ⬍70mg/dL (recommendation for high-risk patients) was achieved in 23% (130) patients. There was a significant correlation with statin use and history of CV disease or at least 1 CV risk factor present (p⫽0.014 for each).
Journal of Clinical Lipidology, Vol 1, No 2, May 2007
not reached goal levels. Furthermore, 40% of men and 24% of women who believed that they had a normal blood pressure were found to have either an elevated systolic or diastolic blood pressure.
Sex
Age TC
Men 28% 45 Women 72% 46
Non10-year HDL TC⬎200 HDL⬎160 risk
188 42 189 57
34% 35%
30% 17%
7% 3%
Framingham Risk Scores and % with abnormal cholesterol
Conclusions: In this retrospective review we concluded that a significant percentage of persons were identified as having hypertension or abnormal serum cholesterol levels but were completely unaware that they had these cardiovascular risk factors. We conclude that persons having significant risk factors for cardiovascular disease may be unaware of their presence. Thus, community programs to appraise cardiovascular risk may be useful to identify and educate individuals with potentially high cardiovascular risk factors. An ongoing study is being conducted to determine if subjects will take action on this information. 112 Effects of Lipid Apheresis on Ambulatory-measured Blood Pressure David B. Romerill, PharmD, Craig D. Williams, Mark A. Deeg, (Houston, TX) Synopsis: LDL apheresis reduces circulating LDL concentrations 40 –50% without removing plasma volume. Reductions in LDL by apheresis have been shown to improve endothelial function but effects on systemic blood pressure and the time course of any effects are not known. Purpose: Determine if LDL apheresis results in a significant reduction in mean arterial blood pressure measured by ambulatory blood pressure monitoring. Methods: 24-hour ambulatory blood pressure monitoring was used to test 6 patients who were undergoing LDL apheresis. Testing was performed 1 day prior to apheresis, 1 day after apheresis and at 1 week in between sessions. All patients were undergoing apheresis every 2 weeks. Blood pressure readings were obtained during testing every 20 minutes during waking hours and every 30 minutes during overnight periods. Pair-wise comparisons were performed to look for differences in systolic, diastolic, mean arterial (MAP) and pulse pressures. Results: Apheresis reduced LDL cholesterol by an average of 45% (range 37–52%). Systolic blood pressure was reduced by 3.3 mmHg on the day after apheresis compared to the day before (mean 125.7 mmHg compared to 122.4 mmHg, p⫽0.007). MAP was reduced by 2.5 mmHg (p ⫽ 0.01). Diastolic pressure and pulse pressure were non-significantly reduced by 1.4 mmHg and 1.9 mmHg (p ⫽ 0.11
and 0.06 respectively). Both systolic pressure and MAP had returned to baseline after 1 week. Conclusions: LDL apheresis reduces both systolic pressure and MAP. These reductions are sustained for less than 1 week. 113 Medication Evaluation in Diabetes to Optimize Statin Therapy (MED-OPS) Sheena Varghese, Maura Brown, Michelle Shaffer, Nicole T. Ansani, (Houston, TX) Synopsis: Diabetes is a risk factor equivalent for coronary heart disease and imposes a significant risk for cardiovascular (CV) morbidity/mortality. National guidelines recommend statin therapy for all adult diabetics; and a goal LDL cholesterol of less than 100mg/dL for diabetes patients. Despite evidence-based guidelines, cholesterol management is not optimal. Quality improvement (QI) efforts should include an analysis of prescribing patterns and goal attainment to provide improvements in evidence-based prescribing. Purpose: The purpose of this QI project was to quantify cholesterol management prescribing trends and goal attainment in diabetic patients. Methods: Fifteen primary care practices participated in a retrospective chart review; 30 –50 patient charts were randomly selected/physician office. Adult patients (18 – 89 years) with type 2 diabetes who visited their primary care physician within the past year and had a cholesterol panel within the past 2 years were included. Data was recorded using HIPAA-compliant data collection records. Outcomes included: demographics (age, gender, CV risk criteria [hypertension, smoking, retinopathy, macro/microalbuminuria], CV past medical history, and hypertension and diabetic medication use), use of statin therapy, and lipid profile. The primary outcomes were percent of diabetic patients on statin therapy and subsequent cholesterol goal attainment (per NCEP ATP III guidelines). Secondary outcomes included correlations between demographics and statin use. Results: Five-hundred and sixty-eight patients were included into the analysis; average age was 67 ⫹ 13 years and 51% of patients were female. Ninety-one percent of patients had at least 1 CV risk factor and 71% were categorized as primary prevention candidates for statin therapy. Results demonstrate that 69% (396) of all diabetics received statin therapy; 66% and 76% of primary and secondary prevention candidates, respectively. Cholesterol goal attainment (LDL ⬍100) was achieved in 63% (358) of all patients, 60% of primary and 71% of secondary prevention candidates. LDL goal ⬍70mg/dL (recommendation for high-risk patients) was achieved in 23% (130) patients. There was a significant correlation with statin use and history of CV disease or at least 1 CV risk factor present (p⫽0.014 for each).