Patients with high cholesterol who are thoroughly trained on their risk for a heart attack seem to respond better to treatment for their cholesterol problem. That's the conclusion of a Canadian study in the
An imbalance of "good" and "bad" cholesterol has long been known to be a risk factor for heart disease. But many patients do not stick to recommended lifestyle changes or stop taking the medications their doctors prescribe. One recent study suggested that one-third of patients who stop taking cholesterol medications do so because they are not convinced they need treatment.
Dr. Steven A. Grover, of McGill University Health Centre in Montreal, decided to find out what would happen if patients received clear explanations of their risks for a heart attack and then received regular feedback from their doctor about the impact their lifestyle changes and their cholesterol medications were making.
Grover selected 3,053 patients with cholesterol problems who were undergoing treatment with lifestyle changes and statin medications. Some of the patients already had heart disease, diabetes, or multiple risk factors for heart disease.
A group of 1,510 patients was randomly assigned to also receive a one-page computer printout of their probability for developing heart disease at the beginning of the study, and then at follow-up visits three, six, nine and 12 months later.
For example, a 43-year-old male smoker who was substantially overweight, with above-average cholesterol and blood pressure levels, was given a printout that told him he had a cardiovascular age equivalent to that of a 51-year-old.
He would have then been told that if all his risk factors were managed according to current Canadian guidelines, he could reduce his cardiovascular age to that of a 42-year-old.
The computerized risk profiles used in the study were based on data from the Framingham Heart Study, and the Cardiovascular Life Expectancy model, previously published by the McGill research team.
After the researchers adjusted for starting cholesterol levels, they found that patients who received their risk profile had small but significantly greater reductions in their LDL (low density lipoprotein) levels and their total cholesterol to HDL (high-density lipoprotein) ratio.
Patients in the group who were better informed about their risk profile were also more likely to reach cholesterol targets. In fact, the higher a patient's cardiovascular risk, the greater they were able to improve their risk profile.
This study shows "that when Canadians become more actively involved in the decisions surrounding their care, they are better equipped to manage their risk for future cardiovascular events," says Dr. Grover.
"Discussing a patient's coronary risk and taking the necessary steps to manage it is an important step in improving preventive care."
