Active Lipid Management In Coronary Artery Disease (ALMICAD) study.
OBJECTIVE
Many providers have implemented specialized lipid clinics to more effectively identify, monitor, and treat hyperlipidemia in patients with coronary artery disease. The effectiveness of such a strategy is not known. We sought to investigate whether a specialized clinic achieves better lipid results and clinical outcomes than standard care.


METHODS
A total of 1233 patients who had coronary disease documented by coronary angiography were randomized to lipid clinic or standard care groups by their providers and followed for 2 years. The primary end point was a composite of death, myocardial infarction, repeat revascularization, and stroke.


RESULTS
Lipid clinic (n=617) and standard care (n=616) groups had no significant baseline differences. After 2 years, the lipid clinic group had similar total cholesterol (166+/-42 mg/dL vs 166+/-41 mg/dL, P=.83), low-density lipoprotein cholesterol levels (84+/-32 vs 85+/-32, P=.28), and percentage of patients with low-density lipoprotein cholesterol less than 100 mg/dL (77.5% vs 77.6%, P=.97). There were no significant differences in the primary end point (12.3% vs 11.4%, P=.60) and mortality (7.6% vs 7.3%, P=.80) between the lipid clinic and standard care groups.


CONCLUSIONS
In patients identified by diagnostic coronary angiography and managed within a single health care system, implementation of a specialized lipid clinic did not achieve greater attainment of hyperlipidemia treatment goals or improved cardiac outcomes.
Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Mich 48202, USA. skhanal1@hotmail.com
Sanjaya
S
Khanal
Omar
O
Obeidat
Michael P
MP
Hudson
Mouaz
M
Al-Mallah
Mary
M
Bloome
Mei
M
Lu
Adam B
AB
Greenbaum
Aaron D
AD
Kugelmass
W Douglas
WD
Weaver
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D000553:Ambulatory Care / Q000379:methods*; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D006949:Hyperlipidemias / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D002784:Cholesterol; D000410:Alanine Transaminase