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November 26, 2007

Using Cardiovascular Age Equivalent to Close the Treatment Gap for Dyslipidemia

Arch Intern Med. 2007;167(21):2288. doi:10.1001/archinte.167.21.2288

The large gap in the quality of care received by the public1 and what we know from clinical trials to be efficacious treatment (evidence-based clinical guidelines) has prompted the study of finding more effective methods of getting evidence into practice.2,3 The CHECK-UP (Cardiovascular Health Evaluation to Improve Compliance and Knowledge Among Uninformed Patients) Study in this issue of the Archives4 is an excellent example of this newly emerging discipline of implementation research. Grover et al4 present findings from a well-designed practice-based clinical trial that tested whether providing high-risk cardiovascular patients with a cardiovascular risk profile conceptualized as an “age equivalent” along with lipid profile results improved optimal cholesterol management consistent with the 2000 Canadian Working Group on Hypercholesterolemia and Other Dyslipidemias lipid guidelines in a primary care setting. Although the intention-to-treat analysis showed a small benefit after 1 year (Δ = −3.3 mg/dL [to convert to millimoles per liter, multiply by 0.0259] for low-density lipoprotein cholesterol between treatment arms) that reached statistical significance (P = .02), when the cardiovascular age was significantly discrepant (see Figure 3, quintiles 4 and 5, in the article by Grover et al4), the percentage of patients reaching guideline-recommended cholesterol goals increased by close to 50%. Such results, if confirmed in other studies, could have real clinical relevance. These results suggest that an informed, activated patient using an “age-equivalent risk communication strategy” as part of a patient-centered approach to cholesterol management seems to be quite effective. Other investigators5 using a similar approach have also demonstrated promising results.

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