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

Glen J Pearson^1,5, Kari L Olson⁶, Nicole E Panich¹, Sumit R Majumdar^2,5, Ross T Tsuyuki^1,4, Dawna M Gilchrist^2,5, Ali Damani⁴, Gordon A Francis^3,5

The MILLARR Study (Maintenance of Improved Lipid Levels Following Attendance at a Cardiovascular Risk Reduction Clinic) ¹Department of Medicine, Divisions of Cardiology; ²General Internal Medicine; ³Endocrinology and Metabolism; Faculty of Pharmacy and Pharmaceutical Sciences; ⁴University of Alberta, Edmonton, Alberta, Canada; ⁵Cardiovascular Risk Reduction Clinic (CRRC), University of Alberta Hospital, Edmonton, Alberta, Canada; ⁶University of Colorado Health Sciences Center, Denver, Colorado, USA; ⁷Family Medicine (Private Practice), Calgary, Alberta, Canada

Background: Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge.

Methods: The medical records of consecutive dyslipidemic patients discharged >6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed. The primary outcome was the change in patients’ lipid levels between the final CRRC visit and the most recent primary care follow-up. A worst-case analysis was conducted to evaluate the potential impact of the patients in whom the follow-up lipid profiles post-discharge from the CRRC were not obtained.

Results: Within the CRRC (median follow-up = 1.28 years in 1064 patients), we observed statistically significant improvements in all lipid parameters. In the 411 patients for whom post-discharge lipid profiles were available (median follow-up = 2.41 years), there were no significant differences observed in low-density lipoprotein-cholesterol, total cholesterol (TC), or triglycerides since CRRC discharge; however, there were small improvements in high-density lipoprotein-cholesterol (HDL-C) and TC:HDL ratio (p < 0.05 for both). The unadjusted worst-case analysis (653 patients with no follow-up lipid profiles) demonstrated statistically significant worsening of all lipid parameters between CRRC discharge and the most recent follow-up. However, when the change in lipid parameters between the baseline and the most recent follow-up was assessed in this analysis, the changes in all lipid parameters were significantly improved (p < 0.05).

Conclusions: This study demonstrates that a CRRC can improve lipid levels and suggests that these benefits are sustained once patients are returned to the care of their primary physician.

Keywords: cardiovascular risk factors, dyslipidemia, outcomes, pharmacotherapy, secondary prevention