Activating Peripheral Arterial Disease Patients to Reduce Cholesterol: A Randomized Trial

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• 作者：Mary M. McDermott MD^a ; ^{mdm608@northwestern.edu"" rel=""nofollow} ; George Reed PhD^b ; Philip Greenland MD^a ; Kathy M. Mazor EdD^b ; Sherry Pagoto PhD^b ; Judith K.Ockene PhD^b ; Rex Graff BA^a ; Philip A. Merriam MSPH^b ; Kathy Leung MS^b ; Larry Manheim PhD^a ; Melina R. Kibbe MD^a ; ^c ; Barbara Olendzki RD^b ; William H. Pearce MD^a ; ^c ; Ira S. Ockene MD^b
• 关键词：Intermittent claudication ; Peripheral arterial disease ; Secondary prevention
• 刊名：The American Journal of Medicine
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：124
• 期：6
• 页码：557-565
• 全文大小：795 K

文摘

Background

Peripheral arterial disease patients are less likely than other high-risk patients to achieve ideal low-density lipoprotein (LDL) cholesterol levels. This randomized controlled trial assessed whether a telephone counseling intervention, designed to help peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician, achieved lower LDL cholesterol levels than 2 control conditions.

Methods

There were 355 peripheral arterial disease participants with baseline LDL cholesterol ≥70 mg/dL enrolled. The primary outcome was change in LDL cholesterol level at 12-month follow-up. There were 3 parallel arms: telephone counseling intervention, attention control condition, and usual care. The intervention consisted of patient-centered counseling, delivered every 6 weeks, encouraging participants to request increases in cholesterol-lowering therapy from their physician. The attention control condition consisted of telephone calls every 6 weeks providing information only. The usual care condition participated in baseline and follow-up testing.

Results

At 12-month follow-up, participants in the intervention improved their LDL cholesterol level, compared with those in attention control (−18.4 mg/dL vs −6.8 mg/dL, P = .010) but not compared with those in usual care (−18.4 mg/dL vs −11.1 mg/dL, P = .208). Intervention participants were more likely to start a cholesterol-lowering medication or increase their cholesterol-lowering medication dose than those in the attention control (54 % vs 18 % , P = .001) and usual care (54 % vs 31 % , P <.001) conditions.

Conclusion

Telephone counseling that helped peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician achieved greater LDL cholesterol decreases than an attention control arm that provided health information alone. © 2011 Elsevier Inc. All rights reserved.