PHYSICIAN RECOGNITION OF HYPERCHOLESTEROLEMIA IN PATIENTS UNDERGOING PERIPHERAL AND CAROTID-ARTERY REVASCULARIZATION

Numerous studies have shown that patients with peripheral and carotid atherosclerosis have a high prevalence of hyperlipidemia, and clinical trials using either angiography or ultrasonography have now demonstra ted regression of both femoral and carotid arterial plaque during lipi d-lowering therapy. However, whether patients with peripheral and caro tid atherosclerosis receive adequate attention to lipid risk factors h as not been studied. To evaluate physician recognition and management of hypercholesterolemia in these two patient populations, we reviewed the charts of 80 consecutive patients undergoing revascularization for symptomatic peripheral and carotid occlusive disease at a university medical center between 1990 and 1993. Physician practices were assesse d for each patient by noting whether hypercholesterolemia was (1) scre ened for during the hospitalization and, if present, (2) documented as a problem, (3) managed in-hospital, or (4) given appropriate interven tion at discharge. While 73% of patients received some type of lipid c ase-finding perioperatively, less than one quarter of these were asses sed for hyperlipidemia by the physician during the initial history. Mo reover, of the 66% of screened patients found to be hypercholesterolem ic, only 16% had documentation of the problem, only 24% received in-ho spital management, and only 13% received intervention at discharge. Th ese findings suggest that patients with documented peripheral and caro tid atherosclerotic vascular disease probably receive inadequate atten tion to lipid risk factors and indicate the need for greater awareness and management of lipid disorders in these two patient populations by all involved physicians.