Non-high-density lipoprotein cholesterol reporting and goal attainment in primary care

作者：Virani Salim S^*; Wang Degang; Woodard LeChauncy D; Chitwood Supicha S; Landrum Cassie R; Zieve Franklin J; Ballantyne Christie M; Petersen Laura A

来源：Journal of Clinical Lipidology, 2012, 6(6): 545-552.

DOI：10.1016/j.jacl.2012.04.080

• Coronary disease
• Diabetes mellitus
• Non-HDL cholesterol
• Prevention
• Treatment goals

BACKGROUND: The Adult Treatment Panel III guidelines established non high-density lipoprotein cholesterol (non-HDL-C) as a secondary treatment target. However, non-HDL-C levels are not reported on standard lipid panels by many hospital-based and/or commercial biochemical laboratories. %26lt;br%26gt;OBJECTIVE: We determined whether reporting non-HDL-C was associated with improved non-HDL-C goal attainment. %26lt;br%26gt;METHODS: We identified patients with cardiovascular disease (CVD) and/or diabetes receiving care within the Veterans Health Administration. We matched a facility that reported non-HDL-C levels on lipid panels (3994 CVD and 5108 diabetes patients) to a facility with similar size, patient complexity, and academic mission that did not report non-HDL-C (4269 CVD and 6591 diabetes patients). We performed patient-level analysis to assess differences in non-HDL-C from baseline to the most recent lipid panel at these facilities. %26lt;br%26gt;RESULTS: Baseline non-HDL-C levels for CVD patients were 114 mg/dL and 107 mg/dL at the reporting and nonreporting facilities, respectively. At 2.3-year follow-up, non-HDL-C levels decreased at both facilities but by a greater amount at the reporting facility (-11 mg/dL vs -3 mg/dL at the nonreporting facility, P %26lt; .001). Results remained significant (P %26lt; .001) after we adjusted for patient%26apos;s age, race, gender, illness burden, history of diabetes, hypertension, medication adherence, statin use, number of lipid panels, and number of primary care visits between baseline and follow-up. Reductions were greater among CVD patients with triglycerides %26gt;= 200 mg/dL (-25 mg/dL vs -16 mg/dL at the respective facilities, P = .004). Results were similar in diabetes patients. Reporting was also associated with greater proportions of patients meeting non-HDL-C treatment goal of %26lt;130 mg/dL. %26lt;br%26gt;CONCLUSION: Non-HDL-C reporting could improve non-HDL-C goal attainment. Published by Elsevier Inc. on behalf of National Lipid Association.

• 出版日期2012-12