Managing Outpatients with Dyslipidemia in a University Hospital

Choi, Ha Jung; Lee, Kayoung; Kim, Bit Na; Park, Tae Jin; Lee, Jeong Nyeo

Abstract

BACKGROUND
We evaluated physician's management of hypercholesterolemia on the basis of the third Adult Treatment Panel (ATP III) report of the National Cholesterol Education Program.
METHODS
The subjects were, 85 adult patients. The inclusion criteria were follows: outpatients with an initial total cholesterol level of > or =200 mg/dL or HDL-cholesterol <40 mg/dL from October to November in 2002, and those visiting the clinic at least three times for the 12 weeks after the baseline test. We reviewed the patients' cardiovascular risk factors (age, low and high HDL, hypertension, history of coronary heart disease (CHD), and diabetes) and the use of LDL-lowering drugs using hospital records. Smoking status and family history of premature CHD were obtained from 19 patients out of 36 patients without CHD or diabetes by telephone. On the whole, cardiovascular risk in 68 patients was identified. Among the total, 52 patients responded to telephone interview concerning education of therapeutic lifestyle change (TLC) provided by a physician.
RESULTS
Forty nine (72.1%) of 68 patients were diagnosed as CHD or diabetes. Fifty three (77.9%) showed undesirable LDL that was categorized by the number of cardiovascular risk factors (> or =160 mg/dL for patients with risk factor<2; > or =130 mg/dL for patients with risk factors > or =2; > or =100 mg/dL for patients with CHD or diabetes). In 59.5% of patients with undesirable LDL reported that they did not provide education about TLC and in 40.0% of patients with desirable LDL were provided prescription of LDL- lowering drugs from physicians. Physicians were more likely to prescribe if the patients had more risk factors (P=0.001) and educated patients when they prescribed them (P=0.049). However, physicians did not educate on TLC and did not recheck lipid profile prior to first prescription.
CONCLUSION
The physicians did not follow the ATP III guideline for management of hypercholesterolemia. Barriers to comply with these guidelines and ways to eliminate barriers should be found.