Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring

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Abstract

Clinical practice guidelines for management of various medical fields are usually validated by expert committees prior critical appraisal of well-designed research. The National Cholesterol Education Program (NCEP) Expert Panel has declared clinical criteria mandatory for initiating lipid-lowering agents and has established optimal therapeutic goals that should be achieved to minimize the risk of coronary heart disease (CHD) and stroke. However, several recent studies have demonstrated limited physicians' recognition and adherence to these guidelines in everyday practice. In addition, the quality of care of patients with hyperlipidemia has varied widely among different health professionals and institutions. The objectives were to assess the physicians' compliance with NCEP guidelines at two community hospitals and to identify the role of clinical pharmacists and their impact on achieving the NCEP goals. A cross-sectional surveys of patients who underwent diagnostic cardiac catheterization between 1995- 2000. A total of 200 patient charts were reviewed. Data obtained included demographic criteria, chief complaints, primary diagnosis, data concerned with risk factors of CHD, diet therapy and whether lipid-lowering agents were prescribed. History of diet and/ or pharmacological lipid lowering therapy was elicited in a total of 141 patients (70%); of which 116 (57.7%) patients had low-cholesterol diet instructions and 81 (40.3%) had drug therapy. An inconsistent pattern was noticed to be followed by physicians in prescribing of various lipid lowering drug groups when stratifying the frequency of treated cases according to various statin types, fibrates, resins, niacin, and combination drug therapy on different LDL-C serum levels. The univariate and multivariate association with initiating lipid lowering drugs was significantly dependent on number of hospital admissions (P=0.025), frequency of recording follow-up lipid profiles (P<0.001), documented diagnosis of CHD (P<0.001), baseline LDL-C risk categories (P<0.001), PTCA/ Stent interventions (P=0.006) and CABG surgery (P=0.03). Furthermore, significant predictors of achieving NCEP goals obtained by multiple logistic regression analysis were diabetes type I (insulin-dependent), PTCA and the unavailability of baseline lipid panel screening. Although 48% of total 145 CHD patients received lipid lowering agents, only 33.8% had a secondary follow-up lipid panel record of LDL-C which revealed that 13% (n=19) met the 1993 successful therapeutic goal of < 100 mg/dL and 10% (n=15) met the previously recommended 1988 goal of < 130 mg/dL. Hence, a "treatment gap" of estimation of 87% was identified in this 200 CHD patients survey which was considered clinically and statistically significant. The extremely limited physicians' adherence to NCEP guidelines despite its wide broadcasting since 1998 and its sooner 1993-update is striking. Therefore, urgent improvement in initiation and titration to goal is mandatory. Finally, The participation of clinical pharmacists is essential to fill the gap between physicians'convictions and "best practice" guidelines.

Original languageEnglish
Pages (from-to)1-25
Number of pages25
JournalJordan Journal of Applied Sciences - Natural Sciences
Volume5
Issue number1
Publication statusPublished - 5 Sep 2003

Fingerprint

Drug Monitoring
Hyperlipidemias
Lipids
Monitoring
Cholesterol
Coronary Disease
Pharmaceutical Preparations
Education
Physicians
Nutrition
Practice Guidelines
Drug therapy
Pharmacists
Guidelines
Diet
Guideline Adherence
Diet Therapy
Fibric Acids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stents

Keywords

  • Coronary heart disease
  • Guidelines
  • Hyperlipidemia
  • Prescribing pattern
  • Therapeutic drug monitoring

Cite this

Shilbayeh, S. (2003). Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring. Jordan Journal of Applied Sciences - Natural Sciences, 5(1), 1-25.
Shilbayeh, Sireen. / Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring. In: Jordan Journal of Applied Sciences - Natural Sciences. 2003 ; Vol. 5, No. 1. pp. 1-25.
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Shilbayeh, S 2003, 'Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring', Jordan Journal of Applied Sciences - Natural Sciences, vol. 5, no. 1, pp. 1-25.

Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring. / Shilbayeh, Sireen.

In: Jordan Journal of Applied Sciences - Natural Sciences, Vol. 5, No. 1, 05.09.2003, p. 1-25.

Research output: Contribution to journalArticleResearchpeer-review

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Shilbayeh S. Management of hyperlipidemia and the urgency for effective therapeutic drug monitoring. Jordan Journal of Applied Sciences - Natural Sciences. 2003 Sep 5;5(1):1-25.