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Application of new cholesterol treatment guidelines lower in clinical practice
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CHICAGO — More than one-third of patients who were adherent to the Adult Treatment Panel III guidelines for cholesterol treatment were no longer adherent when the 2013 American College of Cardiology/American Heart Association guidelines were applied, according to data from a cardiology fellowship outpatient continuity clinic.
Researchers at The Heart Institute at Northside Hospital in St. Petersburg, Florida, performed a retrospective analysis of 500 patients with lipid metabolism disorders at a single outpatient cardiology clinic and determined patient adherence to both the ATP III and 2013 ACC/AHA guidelines regarding LDL levels.
ATP III adherence was observed in 85% of patients vs. 62% for the 2013 guidelines. Among those who were adherent to ATP III recommendations, 63% remained adherent to the ACC/AHA guidelines. Of the patients who were noncompliant with ATP III, 55% were compliant with the 2013 guidelines. The researchers observed no significant differences between patient subgroups.
Jonathan Jordan, DO, a cardiology fellow, told Cardiology Today that the primary reason that patients who had been adherent to ATP III were not adherent to the 2013 guidelines was that most secondary prevention patients had achieved target LDL on a moderate-intensity statin under the earlier recommendations, despite requiring a high-intensity statin according to the new risk calculator.
The researchers concluded that implementation of the 2013 guidelines “would affect treatment and management going forward for a sizeable portion of our patients.” Jordan said the 2013 guidelines did not provide guidance as to how to apply the primary prevention recommendations to patients already assigned statins, and this affected nearly all patients in the analysis because 85% were already assigned statins.
He added that these findings “would spark a discussion with some patients who were adherent with the guidelines previously but now are not based on the intensity of their statins,” who should know that “the data indicates that you may derive more benefit if we increase your statin.” – by Adam Taliercio
Disclosure: Jordan reports no relevant financial disclosures.