Untreated hypercholesterolemia in an emergency department chest pain observation unit population.
OBJECTIVE
To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol-lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines.


METHODS
A cross-sectional study design utilizing a convenience sample of patients from a high-volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point-of-care testing with a cutoff of 190 mg/dL. Those who tested positive had four-hour fasting complete lipid profiles performed by the central laboratory.


RESULTS
There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four-hour fasting total cholesterol level of 224 mg/dL, a low-density lipoprotein (LDL) level of 138 mg/dL, a high-density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol-lowering medications and 91.7% of these patients reported an interest in initiating therapy.


CONCLUSIONS
In this study, approximately 25% of inner-city CPOU patients are possible candidates for cholesterol-lowering interventions. Benefits of initiating therapy during this potential "teachable moment" in a CPOU should be investigated in a subsequent multicenter randomized trial.
Chandra
Abhinav
A
Division of Emergency Medicine, Duke University Medical Center, Durham, NC 27710, USA. chand018@mc.duke.edu
Compton
Scott
S
Sochor
Mark
M
Puri
Sankalp
S
Zalenski
Robert J
RJ
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications / Q000628:therapy*; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018710:Pain Clinics / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010353:Patient Education as Topic; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014504:Urban Health
D000924:Anticholesteremic Agents