title: Lipid control in patients with coronary heart disease treated in primary care or cardiology clinics.
abstract: BACKGROUND
  Guidelines recommend low-density lipoprotein-cholesterol (LDL-C) target of <70 mg/dL in patients with coronary disease. However, this goal is not achieved in many patients.
  
  
  OBJECTIVE
  We compared LDL-C control in patients with coronary disease treated by a primary care physician or with the addition of a cardiologist.
  
  
  METHODS
  Included were patients with coronary disease who had full lipid profile. Primary end points included the percentage of patients who achieved the LDL-C goals of <100 mg/dL and <70 mg/dL.
  
  
  RESULTS
  Of the 27,172 patients, 12,965 (47.7%) were followed only by a primary care physician and 14,207 (52.3%) were also followed by a cardiologist. Overall, 18,366 patients (67.6%) achieved the LDL-C goal of <100 mg/dL, and 6517 patients (24%) achieved the LDL-C goal of <70 mg/dL. Patients followed by a cardiologist more frequently achieved the LDL-C goal of <100 mg/dL (74.3% and 60.3%; P < .0001, in patients treated by a cardiologist or by a primary care physician, respectively), as well as the lower LDL-C goal of <70 mg/dL (27.2% and 20.4%; P < .0001, in patients treated by a cardiologist or by a primary care physician, respectively). Differences in LDL-C control remained significant after a multivariate adjustment. Patients followed by a cardiologist were more commonly treated with highly potent statins and with non-statin cholesterol-lowering drugs.
  
  
  CONCLUSIONS
  Among patients with coronary disease, those followed by a cardiologist receive a more aggressive antilipid treatment and more frequently achieve lipids goals. Nevertheless, the disappointingly poor lipid control in both groups warrants an effort to improve adherence for guidelines in both primary care and cardiology clinics.
authors: Division of Cardiology, Meir Medical Center, 59 Tchernichovsky Street, Kfar-Saba, 44281, Israel; Department of Internal Medicine A, Meir Medical Center, Kfar-Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: davidpe@post.tau.ac.il.
authors: David
authors: D
authors: Pereg
authors: Avishay
authors: A
authors: Elis
authors: Yoram
authors: Y
authors: Neuman
authors: Morris
authors: M
authors: Mosseri
authors: Avi
authors: A
authors: Leader
authors: David
authors: D
authors: Segev
authors: Martine
authors: M
authors: Granek-Catarivas
authors: Michael
authors: M
authors: Lishner
authors: Doron
authors: D
authors: Hermoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D011320:Primary Health Care
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL
keywords: Cholesterol; Coronary disease; Guideline adherence; HMG-CoA reductase inhibitors; Primary health care; Secondary prevention