Pearson Glen J, Olson Kari L, Panich Nicole E, Majumdar Sumit R, Tsuyuki Ross T, Gilchrist Dawna M, Damani Ali, Francis Gordon A
Department of Medicine, Divisions of Cardiology, Cardiovascular Risk Reduction Clinic, University of Alberta Hospital, Edmonton, Alberta, Canada.
Vasc Health Risk Manag. 2008;4(5):1127-35. doi: 10.2147/vhrm.s3748.
Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge.
The medical records of consecutive dyslipidemic patients discharged > 6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed. The primary outcome was the change in patients' lipid levels between the final CRRC visit and the most recent primary care follow-up. A worst-case analysis was conducted to evaluate the potential impact of the patients in whom the follow-up lipid profiles post-discharge from the CRRC were not obtained.
Within the CRRC (median follow-up = 1.28 years in 1064 patients), we observed statistically significant improvements in all lipid parameters. In the 411 patients for whom post-discharge lipid profiles were available (median follow-up = 2.41 years), there were no significant differences observed in low-density lipoprotein-cholesterol, total cholesterol (TC), or triglycerides since CRRC discharge; however, there were small improvements in high-density lipoprotein-cholesterol (HDL-C) and TC:HDL ratio (p < 0.05 for both). The unadjusted worst-case analysis (653 patients with no follow-up lipid profiles) demonstrated statistically significant worsening of all lipid parameters between CRRC discharge and the most recent follow-up. However, when the change in lipid parameters between the baseline and the most recent follow-up was assessed in this analysis, the changes in all lipid parameters were significantly improved (p < 0.05).
This study demonstrates that a CRRC can improve lipid levels and suggests that these benefits are sustained once patients are returned to the care of their primary physician.
心血管疾病专科风险降低诊所（CRRC）可提高患者达到推荐血脂目标的比例；然而，出院后这些益处是否能持续尚不清楚。我们评估了CRRC对血脂水平的影响，并评估了CRRC在出院后维持改善的血脂水平方面的长期效果。
回顾性分析了1991年1月至2001年1月从一家三级医院CRRC出院超过6个月的连续性血脂异常患者的病历。主要结局是患者在CRRC最后一次就诊与最近一次初级保健随访之间血脂水平的变化。进行了最坏情况分析，以评估未获得CRRC出院后随访血脂谱的患者的潜在影响。
在CRRC内（1064例患者的中位随访时间 = 1.28年），我们观察到所有血脂参数均有统计学显著改善。在411例有出院后血脂谱的患者中（中位随访时间 = 2.41年），自CRRC出院后，低密度脂蛋白胆固醇、总胆固醇（TC）或甘油三酯无显著差异；然而，高密度脂蛋白胆固醇（HDL-C）和TC:HDL比值有小幅改善（两者p < 0.05）。未经调整的最坏情况分析（653例无随访血脂谱的患者）显示，CRRC出院与最近一次随访之间所有血脂参数有统计学显著恶化。然而，在此分析中评估基线与最近一次随访之间血脂参数的变化时，所有血脂参数的变化均有显著改善（p < 0.05）。
本研究表明CRRC可改善血脂水平，并提示一旦患者回到初级医生的照料下，这些益处能够持续。
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