Potential influence of timing of low-density lipoprotein cholesterol evaluation in patients with acute coronary syndrome.
OBJECTIVE
To determine the significance of timing of low-density lipoprotein (LDL) cholesterol evaluation in patients with chest pain as it relates to subsequent National Cholesterol Education Program (NCEP) treatment decisions.


METHODS
Prospective, observational study.


METHODS
A university-affiliated tertiary care hospital.


METHODS
Sixty-two patients with coronary heart disease who were not receiving lipid-lowering therapy and whose LDL levels were obtained 25-48 hours after onset of chest pain.


METHODS
We evaluated laboratory test results of patients with chest pain admitted to the cardiac care unit to determine risk to patients when LDL levels obtained inappropriately are used to make decisions regarding antihyperlipidemic therapy.


RESULTS
Inpatient and outpatient LDL levels were compared, and changes in NCEP treatment decisions analyzed. Differences between inpatient and outpatient LDL levels were significant (p<0.05), which frequently resulted in changes in therapy using the NCEP guidelines. The LDL levels of most inpatients were consistent with NCEP goals for patients with coronary heart disease, whereas the outpatient levels showed a need for drug therapy.


CONCLUSIONS
Lipid values obtained 25-48 hours after hospital admission in patients with acute coronary syndromes do not represent baseline values and may significantly alter the treatment approach; thus, they should not be used to direct drug therapy.
Faulkner
M A
MA
Creighton University School of Pharmacy and Allied Health Professions, Department of Pharmacy Practice, Omaha, NE 68178, USA.
Hilleman
D E
DE
Destache
C J
CJ
Mooss
A N
AN
D000208:Acute Disease; D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood*; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
D008078:Cholesterol, LDL