title: Effect of a 36-month pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients.
abstract: OBJECTIVE
  To examine the effect of a pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients.
  
  
  METHODS
  A total of 200 elderly (> 60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements were evaluated at the baseline and up to 36 months afterwards. The intervention group patients received pharmaceutical care from a clinical pharmacist, whereas the control group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk scores of all the patients.
  
  
  RESULTS
  A total of 194 patients completed the study. Significant reductions (p < 0.05) in the mean values (baseline vs. 36 months) for the systolic blood pressure [156.7 mmHg vs 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001),fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P <0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL)cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m2 vs. 26.1 kg/m2; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P= 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group.
  
  
  CONCLUSIONS
  The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.
authors: Department of Pharmacology and Therapeutics, State University of Maringá, Maringá, PR, Brazil. paulorobreli@yahoo.com.br
authors: Paulo Roque Obreli
authors: PR
authors: Neto
authors: Srecko
authors: S
authors: Marusic
authors: Divaldo Pereira
authors: DP
authors: de Lyra Júnior
authors: Diogo
authors: D
authors: Pilger
authors: Joice Mara
authors: JM
authors: Cruciol-Souza
authors: Walderez Penteado
authors: WP
authors: Gaeti
authors: Roberto Kenji Nakamura
authors: RK
authors: Cuman
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology / Q000517:prevention & control*; D023381:Endpoint Determination / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods; D010593:Pharmaceutical Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference / Q000187:drug effects; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human