title: Intervention to improve adherence to lipid-lowering medication and lipid-levels in patients with an increased cardiovascular risk.
abstract: Low levels of statin adherence may compromise treatment outcomes. The aim of this study was to investigate whether nurse-led cardiovascular risk-factor counseling could improve statin adherence and lipid levels without increasing patients' anxiety. Patients with indications for statin therapy for primary or secondary prevention of cardiovascular disease were randomly assigned to receive routine care or extended care (EC) at baseline and at months 3, 9, and 18. Patients in the EC group received a personalized risk-factor passport, showing modifiable and unmodifiable individual risk factors and a graphical presentation of their calculated absolute 10-year cardiovascular disease risk as well as the target risk that could be reached if all modifiable risk factors were optimally treated. Lipid levels were assessed at each visit. Carotid intima-media thickness was measured at baseline and at month 18. Adherence, anxiety, quality of life, symptoms, and smoking status were assessed using a self-administered questionnaire at each visit. A total of 201 patients were included in the study. Statin adherence was significantly higher (p <0.01) and anxiety was significantly lower (p <0.01) in the EC group than in the routine care group. Low-density lipoprotein cholesterol was statistically significantly lower in the EC group than in the routine group (2.66 vs 3.00 mmol/L, respectively, p = 0.024) in primary prevention patients only. Intima-media thickness improved significantly from baseline (p <0.01) in all patients, irrespective of group assignment. In conclusion, cardiovascular risk-factor counseling resulted in improved lipid profiles in primary prevention patients and higher levels of adherence to statins and lower levels of anxiety in all patients.
authors.affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.t.nieuwkerk@amc.uva.nl
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.forename: Melchior C
authors.initials: MC
authors.lastname: Nierman
authors.forename: Maud N
authors.initials: MN
authors.lastname: Vissers
authors.forename: Mirjam
authors.initials: M
authors.lastname: Locadia
authors.forename: Phillip
authors.initials: P
authors.lastname: Greggers-Peusch
authors.forename: Léon P M
authors.initials: LP
authors.lastname: Knape
authors.forename: John J P
authors.initials: JJ
authors.lastname: Kastelein
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: de Haes
authors.forename: Erik S G
authors.initials: ES
authors.lastname: Stroes
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006949:Hyperlipidemias / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D024802:Nurse's Role; D005791:Patient Care / Q000379:methods; D011322:Primary Prevention / Q000379:methods; D058996:Quality Improvement; D012016:Reference Values; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors