Intervention to Improve Adherence to Lipid-Lowering Medication and Lipid-Levels in Patients With an Increased Cardiovascular Risk

• Published in: The American journal of cardiology Vol. 110; no. 5; pp. 666 - 672
• Main Authors: Nieuwkerk, Pythia T., PhD, Nierman, Melchior C., MD, PhD, Vissers, Maud N., PhD, Locadia, Mirjam, PhD, Greggers-Peusch, Phillip, MD, Knape, Léon P.M., MD, Kastelein, John J.P., MD, PhD, Sprangers, Mirjam A.G., PhD, de Haes, Hanneke C., PhD, Stroes, Erik S.G., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2012; Elsevier; Elsevier Limited
• Subjects: Anxiety; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Body mass index; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Cholesterol; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Confidence intervals; Counseling; Drug Administration Schedule; Female; Follow-Up Studies; Gender; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hyperlipidemias - complications; Hyperlipidemias - diagnosis; Hyperlipidemias - drug therapy; Hyperlipidemias - nursing; Lipids; Low density lipoprotein; Male; Medical sciences; Medication Adherence - statistics & numerical data; Mental health; Middle Aged; Netherlands; Nurse's Role; Patient Care - methods; Primary Prevention - methods; Quality Improvement; Questionnaires; Reference Values; Risk factors; Severity of Illness Index; Smoking cessation; Studies; Time Factors; Treatment Outcome; Triglycerides; Ultrasonic imaging; Veins & arteries; Netherlands; Human; Lipids; Patient; Cardiovascular disease; Adhesion; Vascular disease; Chemotherapy; Treatment; Atherosclerosis; Risk factor; Level; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.04.045

Low levels of statin adherence may compromise treatment outcomes. The aim of this study was to investigate whether nurse-led cardiovascular risk-factor counseling could improve statin adherence and lipid levels without increasing patients' anxiety. Patients with indications for statin therapy for primary or secondary prevention of cardiovascular disease were randomly assigned to receive routine care or extended care (EC) at baseline and at months 3, 9, and 18. Patients in the EC group received a personalized risk-factor passport, showing modifiable and unmodifiable individual risk factors and a graphical presentation of their calculated absolute 10-year cardiovascular disease risk as well as the target risk that could be reached if all modifiable risk factors were optimally treated. Lipid levels were assessed at each visit. Carotid intima-media thickness was measured at baseline and at month 18. Adherence, anxiety, quality of life, symptoms, and smoking status were assessed using a self-administered questionnaire at each visit. A total of 201 patients were included in the study. Statin adherence was significantly higher (p <0.01) and anxiety was significantly lower (p <0.01) in the EC group than in the routine care group. Low-density lipoprotein cholesterol was statistically significantly lower in the EC group than in the routine group (2.66 vs 3.00 mmol/L, respectively, p = 0.024) in primary prevention patients only. Intima-media thickness improved significantly from baseline (p <0.01) in all patients, irrespective of group assignment. In conclusion, cardiovascular risk-factor counseling resulted in improved lipid profiles in primary prevention patients and higher levels of adherence to statins and lower levels of anxiety in all patients.