Missed Opportunity in the Treatment of Hyperlipidemia in Patients with Coronary Heart Disease: The Primary Care Setting. RESULTS

Patients with Coronary Heart Disease RESULTS

Demographics One-hundred-forty-seven patients were identified as having CHD. The mean age of the patients was 66 ± 11 years, and 54.4% of the patients were women. The majority (91.8%) of the patients were African-American. Most patients were indigent and few had private insurance. The comorbidities of the patients are displayed in Table 1. In general, there was a high incidence of hypertension (99.3%), diabetes (46.2%) and heart failure (29.9%).

Table 1. Demographics, CHD risk factors and cardiovascular diagnoses of the CHD cohort (n=147)

Demographics

Value (Percentage or ± SD)
Mean age, years

66.30 ± 10.98

Gender
Male

67 (45.6%)

Female

80 (54.4%)

Race
African-American

135 (91.8%)

White

12 (8.2%)

CHD Risk Factors

Diabetes

67 (46.2%)

Hypertension

146 (99.3%)

Mean systolic BP (mmHg)

140.9 ± 21.1

Mean diastolic BP (mmHg)

73.9 ± 14.9

Lipids
Mean total cholesterol (mg/dl)

200.2 ± 101.1

Mean triglycerides (mg/dl)

133.5 ± 72.1

Mean LDL (mg/dl)

113.4 ±40.0

Mean HDL (mg/dl)

51.0 ± 16.5

Current smoker

29 (19.7%)

Cardiovascular Diagnosis

Coronary artery disease               147 (100%)
Myocardial infarction                  35 (23.8%)
Congestive heart failure (EF <40%)  44 (29.9%)
Cerebral vascular disease             13 (8.8%)
Peripheral vascular disease            13 (8.8%
SD: standard deviation; mmHg: millimeters of mercury; mg/dl: milliliters per deciliter; EF: ejection fraction

Frequency of Cardiovascular Drug Treatment

Table 2 depicts the number of patients on different cardiovascular therapies. The frequency at which patients were on aspirin or other antiplatelet therapy was high (88.4%). The frequency at which patients were on cholesterol-reducing therapy and, in particular, statins (74.8%), was also relatively high. The use of beta-blocker therapy was 60.5%, and the use of ACE inhibitors was 60.0%. Forty percent of the cohort were on diabetes medications and 13.0% were on digoxin. You can afford your pills. Buy levitra plus online

Table 2. Number of CHD patients on medical therapies

Therapy                     Number of Patients {%)

ASA/antiplatelet 130 (88.4%)
Cholesterol-Lowering Drugs 110 (74.8%)
Statin* 110 (74.8%)
Cholestyramine1 3 (2.0%)
Gemfibrozil 2 (1.4%)
Antihypertensives/Antianginal Drugs
Beta-blocker 89 (60.5%)
ACE inhibitor 88 (60.0%)
Diuretic 86 (58.5%)
Calcium channel blocker 60 (40.8%)
Angiotensin-receptor blocker 1 (0.7%)
Diabetes medication 58 (40.0%)
Digoxin 19 (13.0%)
Anticoagulant 12 (8.2%)
* Ninety-nine patients (90.0%) on statins were on simvastatin
due to formulary considerations; t All patients on either
cholestyramine or gemfibrozil were also on a statin.

Lipids and Cholesterol Drug Therapy

Only 81.6% of the cohort had a documented LDL cholesterol in the last six months (Table 3). The mean LDL of the population was 113 mg/dl. The majority of the patients with known LDL values (n=120) had LDL values of <160 mg/dl, but only 55 (45.8%) had an LDL of < 100 mg/dl. There was a considerable portion of the patients who had an LDL value between 100-130 mg/dl (29.2%). All of the patients on lipid-lowering therapy (74.8%) were treated with a statin (Table 2), with the predominate statin being simvastatin due to formulary considerations. Of these patients, 4.5% were on combination therapy with either a bile-acid sequestrant or a fibrate. The mean dose of statin utilized was 33.3 mg, and the majority of patients (54.6%) were taking 40 mg of simvastatin (Table 4). Only seven patients (6.5%) were taking the maximum statin dose of 80 mg. Source your medication needs online. Buy cialis professional home delivered

Table 3. Risk factor control in CHD patients

Risk Factor

Number of Patients (%)
LDL Cholesterol
<160 mg/dl

103 (85.8%)

<130 mg/dl

90 (75.0%)

<100 mg/dl

55 (45.8%)

No LDL available*

27 (18.4%)

Systolic Blood Pressure <140 mmHg

70 (47.6%)

Diastolic Blood Pressure <90 mmHg

122 (83.0%)

Diabetes Hemoglobin A1C <7%f                  42 (62.7%)
Fasting blood glucose <126mg/dlf   51 (76.1%)
mg/dl: milligrams per deciliter; mmHg: millimeters of mercury; * Twenty-seven patients had no LDL value in previous six months; f Hemoglobin А1С and fasting blood glucose values were recorded in diabetics only.

There were no differences in lipid treatment by gender, race, age (>65) or the presence of diabetes. The only significant predictor of not receiving a statin was the presence of congestive heart failure. Twenty-seven of 44 such patients (61%) of the cohort received a statin (p=0.03) (data not shown). Buy flomax canada

Table 4. Number of Patients on Statin Doses (n=108)*

Dose

Value (Percentage or ± SD)
Mean dose (mg)

33.3 ± 17.1

Individual Doses (mg)
10

17 (15.7%)

20

25 (23.1%)

40

59 (54.6%)

80

7 (6.5%)

SD: standard deviation; mg: milligrams; * Two patients had an
unclear statin dose due to chart and pharmacy discrepancies.

Other Risk Factor ManagementDiabetes was fairly well controlled, although many of the patients were not at goal (hemoglobin A1C <7% or fasting blood glucose <126 mg/dl). Hypertension was less well controlled, with only 70 patients (47.6%) with systolic blood pressures <140 mmHg. Diastolic blood pressure was better controlled with 122 patients (83.0%) with values <90 mmHg.

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