TY - JOUR
T1 - Exploring the gap between National Cholesterol Education Program guidelines and clinical practice in secondary care
T2 - Results of a cross-sectional study involving over 10 000 patients followed in different specialty settings across Italy
AU - Rapezzi, Claudio
AU - Biagini, Elena
AU - Bellis, Paolo
AU - Cafiero, Massimo
AU - Velussi, Mario
AU - Ceriello, Antonio
AU - Cooke, Robin M T
AU - Schweiger, Carlo
PY - 2008/9
Y1 - 2008/9
N2 - Objectives To evaluate implementation of low-density lipoprotein cholesterol (LDL-C) control recommendations in secondary care and explore key points in the decisional workup. Methods and results In a nationwide survey of secondary- care outpatients (n = 11124), we studied prevalence/ predictors of (1) LDL-C value availability; (2) ongoing treatment with statins; (3) achievement of US National Cholesterol Education Program III target LDL-C values. Agreement between US National Cholesterol Education Program III risk category and physicians' personal risk assessments was also studied. LDL-C values were available for 78% evaluable patients; 71% of the patients with dyslipidema were undergoing treatment with statins; 34% patients undergoing treatment had target LDL-C values. At regression analysis, non-availability of LDL-C values was predicted by absence of diabetes, presence of normotension, and advancing age; lack of statins treatment by female sex, diabetes, overweight and northern location (southern location predicted treatment); non-achievement of target LDL-C values by age, diabetes, attending a diabetic clinic, cigarette smoking, history of cardiovascular disease, and taking less than six pills per day. Physicians provided underestimates of patients' risk (39% high-risk patients were rated as intermediate-risk patients and a further 10% as low-risk patients). Conclusion Suboptimal prevention practice seems to be associated with various factors acting at different levels within the complex process running from individual risk-level ascertainment to LDL-C target achievement. Multicomponent interventions that target the different key steps need to be considered.
AB - Objectives To evaluate implementation of low-density lipoprotein cholesterol (LDL-C) control recommendations in secondary care and explore key points in the decisional workup. Methods and results In a nationwide survey of secondary- care outpatients (n = 11124), we studied prevalence/ predictors of (1) LDL-C value availability; (2) ongoing treatment with statins; (3) achievement of US National Cholesterol Education Program III target LDL-C values. Agreement between US National Cholesterol Education Program III risk category and physicians' personal risk assessments was also studied. LDL-C values were available for 78% evaluable patients; 71% of the patients with dyslipidema were undergoing treatment with statins; 34% patients undergoing treatment had target LDL-C values. At regression analysis, non-availability of LDL-C values was predicted by absence of diabetes, presence of normotension, and advancing age; lack of statins treatment by female sex, diabetes, overweight and northern location (southern location predicted treatment); non-achievement of target LDL-C values by age, diabetes, attending a diabetic clinic, cigarette smoking, history of cardiovascular disease, and taking less than six pills per day. Physicians provided underestimates of patients' risk (39% high-risk patients were rated as intermediate-risk patients and a further 10% as low-risk patients). Conclusion Suboptimal prevention practice seems to be associated with various factors acting at different levels within the complex process running from individual risk-level ascertainment to LDL-C target achievement. Multicomponent interventions that target the different key steps need to be considered.
KW - Cardiovascular prevention
KW - Low-density lipoprotein cholesterol
KW - Risk factors
KW - Statins
KW - Us national cholesterol education program
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U2 - 10.2459/JCM.0b013e3282f56513
DO - 10.2459/JCM.0b013e3282f56513
M3 - Article
C2 - 18695423
AN - SCOPUS:55249089482
VL - 9
SP - 878
EP - 887
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
SN - 1558-2027
IS - 9
ER -