Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience

Figures & data

Figure 1 Flow diagram of study patient disposition.

Abbreviations:

Table 1 Patient demographics

Parameter	All patients (n = 1064)	Patients with follow-up (n = 411)	Patients with no follow-up (n = 653)
Age (mean ± SD)	51.9 ± 12.4	52.6 ± 11.5	57.4 ± 13.0
Sex
Males	619 (58.2%)	215 (52.3%)	404 (61.9%)
Females	445 (41.8%)	196 (47.7%)	249 (38.1%)
Documented vascular disease*
Prior myocardial infarction	210 (19.7%)	75 (18.2%)	135 (20.7%)
Angina	175 (16.4%)	62 (15.1%)	113 (17.3%)
Percutaneous coronary intervention	111 (10.4%)	44 (10.7%)	67 (10.3%)
Coronary artery bypass graft surgery	118 (11.1%)	43 (10.5%)	75 (11.5%)
Transient ischemic attack	31 (2.9%)	12 (2.9%)	19 (2.9%)
Stroke	32 (3.0%)	9 (2.2%)	23 (3.5%)
Peripheral vascular disease	47 (4.4%)	11 (2.7%)	36 (5.5%)
Diabetes mellitus	162 (15.2%)	63 (15.3%)	99 (15.2%)
High risk patients (history of vascular disease or diabetes)	473 (44.4%)	172 (41.8%)	301 (46.1%)
Distribution of risk factors
Hypertension	390 (36.7%)	151 (36.7%)	239 (36.6%)
Current smoker	214 (20.1%)	80 (19.5%)	134 (20.5%)
Positive family history	642 (60.3%)	251 (61.1%)	391 (59.9%)
Left ventricular hypertrophy	29 (2.7%)	5 (1.2%)	24 (3.7%)
Other factors
Impaired fasting glucose or impaired glucose tolerance	69 (6.5%)	27 (6.6%)	42 (6.4%)
Solid organ transplant	47 (4.4%)	8 (1.9%)	39 (6.0%)
Number of risk factors identified among nonhigh risk patients (mean)	2	2	2

Note: *not mutually exclusive.

Table 2 Change in mean lipid levels in 1,064 patients during CRRC attendance

Lipid parameter	Visit I -(Baseline)	Final visit (Discharge)	Change
			Mean (%)	p-value
TC (mmol/L)	6.99	5.73	−1.25 (17.9)	<0.0001
LDL-C (mmol/L)	4.25	3.39	−0.81 (19.1)	<0.0001
HDL-C (mmol/L)	1.12	1.21	+0.10 (8.9)	<0.0001
TG (mmol/L)	4.49	2.74	−1.81 (40.3)	<0.0001
TC:HDL	6.44	5.03	−1.47(22.8)	<0.0001

Notes: Median duration of follow-up in the CRRC (time interval between Clinic Visit I and Final Visit) = 1.28 years.

Abbreviation: CRRC, Cardiovascular Risk Reduction Clinic.

Table 3 Frequency of lipid-lowering medications used (at any time) during CRRC attendance

Medication		Frequency (# of instances used)	% Patients (n = 1064)
HMG-CoA (statin)		880	82.7
	Atorvastatin	260	24.4
	Pravastatin	238	22.4
	Simvastatin	236	22.2
	Lovastatin	76	7.1
	Fluvastatin	45	4.2
	Cerivastatin	25	2.3
Fibric acid derivative (fibrate)		508	37.9
	Fenofibrate	386	26.4
	Gemfibrozil	102	9.6
	Bezafibrate	20	1.9
Nicotinic acid (niacin)		138	13.0
	Regular-release	104	9.8
	Timed-release	34	3.2
Bile acid sequestrants (resin)		65	6.1
	Cholestyramine	39	3.7
	Colestipol	26	2.4
Others (Clofibrate, Salmon Oil)		2	0.2

Abbreviations: CRRC, Cardiovascular Risk Reduction Clinic; HMG-CoA, 3-hydroxy-3-methyl-glutaryl-CoA reductase.

Table 4 Frequency of various combination regimens used (at any time) during CRRC attendance

Combination regimen	Frequency (#of Instances Used)	% Patients (n = 1064)
Statin + Fibrate	139	13.1%
Statin + Niacin	25	2.4%
Statin + Resin	22	2.1%
Statin + Fish Oil	1	0.1%
Fibrate + Niacin	7	0.7%
Fibrate + Resin	2	0.2%
Niacin + Resin	2	0.2%
Statin + Niacin + Fibrate	3	0.3%
Statin + Niacin + Resin	1	0.1%
Statin + Fibrate + Resin	1	0.1%
TOTAL	203	19.1%

Abbreviation: CRRC, Cardiovascular Risk Reduction Clinic.

Table 5 Change in mean lipid levels in 411 patients following discharge from the CRRC

Lipid parameter	Visit I-(Baseline)	Final visit (Discharge)	Follow-up*	Mean change (95% CI†)
				Visit I to final visit	Visit I to follow-up	Discharge to Follow-up*
TC (mmol/L)	7.13	5.81	5.77	−1.32‡ (−1.59, −1.04)	−1.36‡ (−1.64, −1.07)	−0.04 (−0.19, +0.1)
LDL-C (mmol/L)	4.34	3.44	3.37	−0.90‡ (−1.07, −0.73)	−0.97‡ (−1.14, −0.80)	−0.07 (−0.21, +0.07)
HDL-C (mmol/L)	1.13	1.24	1.27	+0.11‡ (+0.08, +0.14)	+0.14‡ (+0.11, +0.17)	+0.03‡ (+0.01, +0.06)
TG (mmol/L)	4.84	2.62	2.64	−2.22‡ (−3.11, −1.34)	−2.20‡ (−3.11, −1.30)	+0.02 (−0.20, +0.24)
TC:HDL	6.54	5.05	4.85	−1.49‡ (−1.71, −1.27)	−1.69‡ (−1.95, −1.42)	−0.20‡ (−0.39, 0.006)

Notes: *Median duration of follow-up since CRRC discharge = 2.41 years (minimum = 0.5 years).

^†Tukey-Kramer adjustment.

^‡p<0.05.

Abbreviations: CRRC, Cardiovascular Risk Reduction Clinic; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; TC, total cholesterol; TG, triglycerides.

Table 6 Change in mean lipid levels in patients (n = 1064) following discharge from the CRRC by worst-case analysis

Lipid parameter	Visit I-(Baseline)	Final visit (Discharge)	Follow-up	Mean** change (95% CI†)
				Visit I to follow-up	Discharge to follow-up
TC (mmol/L)	6.98	5.73	6.46	−0.53‡ (−0.63, −0.43)	+0.72‡ (+0.58, +0.86)
LDL-C (mmol/L)	4.1	3.38	3.75	−0.39‡ (−0.46, −0.33)	+0.38‡ (+0.29, +0.46)
HDL-C (mmol/L)	1.11	1.21	1.17	+0.06‡ (+0.04, +0.07)	−0.04‡ (−0.06, − 0.02)
TG (mmol/L)	4.53	2.73	3.70	−0.83‡ (−1.12, −0.54)	+0.97‡ (+0.68, +1.25)
TC:HDL	6.45	5.04	5.79	−0.67‡ (−0.77, −0.57)	+0.75‡ (+0.61, +0.89)

Notes: *411 patients had follow-up information and the follow-up lipid values of the remaining 653 patients were imputed from their initial lipid values (baseline at the time of clinic referral);

**Means are least square means and differences in least square means estimates using generalized least squares approach;

^†Tukey-Kramer adjustment;

^‡p × 0.05

Abbreviations: CRRC, Cardiovascular Risk Reduction Clinic; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; TC, total cholesterol; TG, triglycerides.