Clinical InvestigationCoronary Artery DiseaseLipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines
Section snippets
Methods
Details of GWTG CAD have been previously published.4 In brief, the American Heart Association (Dallas, TX) launched the GWTG program to support and facilitate the improvement of the quality of care of patients with cardiovascular disease. Get With The Guidelines uses a Web-based patient management tool (Outcome Sciences Inc, Cambridge, MA) to collect clinical data, provide decision support, and provide real-time online reporting features. Data collected included patient demographics, medical
Results
During the 76 months of the study in 231,896 CAD hospitalizations from 541 hospitals, lipid levels were obtained in the first 24 hours of hospitalization in 136,905 (59.0%). Patients with and without lipid levels obtained on admission showed modest differences: age (65 vs 69 years), female sex (63% vs 59%), prior CHD, other atherosclerotic vascular disease, or diabetes (46% vs 40%), and treatment with lipid-lowering medications before hospitalization (21% vs 16%). The clinical characteristics
Discussion
Numerous studies have demonstrated that total cholesterol and LDL are major modifiable risk factors for atherosclerotic vascular disease and its clinical manifestations. Prospective epidemiological data have suggested that the relationship between LDL and CHD is log-linear, with a relative risk set at 1.0 for LDL of 40 mg/dL.2 A large number of randomized clinical trials have demonstrated that lowering LDL with certain lipid-lowering medications reduces the risk of first or recurrent
Conclusions
In a large cohort of patients hospitalized with CAD, almost half have admission LDL <100 mg/dL, whereas less than a quarter have LDL >130 mg/dL. The LDL levels <70 mg/dL are observed in only 17.6% of patients. Admission HDL levels are <40 mg/dL in 54.6% of patients hospitalized with CAD, whereas <10% of patients have admission HDL levels ≥60 mg/dL. Ideal lipid levels (LDL <70 mg/dL with HDL ≥60 mg/dL) are seen in only 1.4% of patients hospitalized with CAD. There were reductions in admission
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The Get With The Guidelines Program is supported by the American Heart Association (Dallas, TX) in part through an unrestricted education grant from the Merck Schering Plough Partnership (North Wales, PA) who did not participate in the design, analysis, preparation, review, or approval of this article.
Financial disclosures: Amit Sachdeva, MD (none); Christopher P. Cannon, MD (grants: Accumetrics [San Diego, CA], AstraZeneca [Wilmington, DE], Bristol-Myers Squibb [New York, NY], GlaxoSmithKline [Philadelphia, PA], Merck [Whitehouse Station, NJ], Sanofi-Aventis [Bridgewater, NJ], Schering Plough [Kenilworth, NJ]); Prakash C. Deedwania, MD (consultant of AstraZeneca and Pfizer [New York, NY]); Kenneth A. LaBresh, MD (none); Sidney C. Smith, Jr., MD (none); David Dai, PhD (employee of Duke Clinical Research Institute [Durham, NC]); Adrian Hernandez, MD (none); Gregg C. Fonarow, MD (research from Pfizer and GlaxoSmithKline; consultant and honorarium from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer, and Schering Plough; and chair of the Get With the Guidelines Steering Committee).
Dr. Todd D. Miller served as guest editor for this manuscript.