Preventive cardiology
Intervention to Improve Adherence to Lipid-Lowering Medication and Lipid-Levels in Patients With an Increased Cardiovascular Risk

https://doi.org/10.1016/j.amjcard.2012.04.045Get rights and content

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.

Section snippets

Methods

Patients (aged >18 years) with indications for statin use (primary or secondary prevention of cardiovascular events) were consecutively selected from the outpatient clinics of 2 hospitals in Amsterdam, The Netherlands (Academic Medical Center and the Slotervaart Hospital) by their treating physicians and included from May 2002 to May 2004. Patients with severe fasting dyslipidemia (total cholesterol >9.0 mmol/L or triglycerides >4.0 mmol/L) were excluded, as were those with fasting glucose >7.0

Results

A total of 201 consecutive patients were enrolled (Figure 2). Characteristics at baseline are listed in Table 1. There were no statistically significant differences in baseline characteristics between patients in the 2 study arms within the subgroups of primary and secondary prevention patients.

LDL cholesterol was statistically significantly lower in the EC group than in the RC group during follow-up in primary prevention patients but not in secondary prevention patients (Table 2, Figure 3).

Discussion

In this randomized controlled trial, nurse-led multifactorial cardiovascular risk-factor counseling resulted in higher levels of adherence to lipid-lowering medication and lower LDL cholesterol concentrations in primary prevention patients, without increasing patients' anxiety compared to RC. LDL cholesterol reductions were significantly related to improved adherence to statins, also when adjusted for the dose and type of the statin. High-density lipoprotein cholesterol, triglycerides, IMT, and

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    This study was funded in part by Pfizer (Capelle aan den IJssel, The Netherlands).

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