Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial.
BACKGROUND
Despite increasing evidence that treating dyslipidemia reduces cardiovascular events, many patients do not achieve recommended lipid targets.


METHODS
To determine whether showing physicians and patients the patient's calculated coronary risk can improve the effectiveness of treating dyslipidemia in a primary care setting, patients were randomized to receive usual care or ongoing feedback regarding their calculated coronary risk and the change in this risk after lifestyle changes, pharmacotherapy, or both to treat dyslipidemia. Outcomes, based on intention-to-treat analysis, included changes in blood lipid levels, coronary risk, and the frequency of reaching lipid targets.


RESULTS
Two hundred thirty primary care physicians enrolled 3,053 patients. After 12 months of follow-up, 2,687 patients (88.0%) remained in the study. After adjustment for baseline lipid values, significantly greater mean reductions in low-density lipoprotein cholesterol levels and the total cholesterol to high-density lipoprotein cholesterol ratio were observed in patients receiving risk profiles (51.2 mg/dL [to convert to millimoles per liter, multiply by 0.0259] and 1.5, respectively) vs usual care (48.0 mg/dL and 1.3, respectively), but the differences were small (-3.3 mg/dL; 95% confidence interval [CI], -5.4 to -1.1 mg/dL; and -0.1; 95% CI, -0.2 to -0.1, respectively). Patients in the risk profile group were also more likely to reach lipid targets (odds ratio, 1.26; 95% CI, 1.07 to 1.48). A significant dose-response effect was also noted when the impact of the risk profile was stronger in those with worse profiles.


CONCLUSIONS
Discussing coronary risk with the patient is associated with a small but measurable improvement in the efficacy of lipid therapy. The value of incorporating risk assessment in preventive care should be further evaluated.
McGill Cardiovascular Health Improvement Program and the Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Department of Medicine, McGill University, Montreal, Canada. steven.grover@mcgill.ca
Steven A
SA
Grover
Ilka
I
Lowensteyn
Lawrence
L
Joseph
Mohammed
M
Kaouache
Sylvie
S
Marchand
Louis
L
Coupal
Ghislain
G
Boudreau
D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D019359:Knowledge; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D008055:Lipids; D002784:Cholesterol