NURSE-MEDIATED CHOLESTEROL MANAGEMENT COMPARED WITH ENHANCED PRIMARY-CARE IN SIBLINGS OF INDIVIDUALS WITH PREMATURE CORONARY-DISEASE

Background: Siblings of individuals with premature coronary heart dise ase have a high prevalence of low-density lipoprotein cholesterol (LDL -C) levels requiring treatment. Objective: To evaluate management stra tegies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior t o age 60 years. Methods: In a 2-year trial of care provided by either a nurse trained in lipid management (NURS) or enhanced primary care (E PC), in which physicians received recommendations based on national gu idelines, 156 siblings with LDL-C levels of 4.14 mmol/L (160 mg/ dL) w ere randomized by family. The LDL-C goal levels below 3.36 mmol/L (130 mg/dL) were compared between and within intervention groups. Multiple logistic regression analyses were applied to predict 2-year achieveme nt of the goal. Results: The NURS group achieved a significantly great er percentage of goal LDL-C levels than the EPC group (26% vs 10%; P=. 008). The NURS LDL-C levels decreased an average of 0.91 mmol/L (35 mg /dL) while EPC levels decreased by 0.52 mmol/L (24 mg/dL) (P =.09). In the final multivariate model, siblings taking lipid-lowering drug tre atment were 6.02 times more likely (95% confidence interval, 2.24-16.1 8) than those not receiving pharmacotherapy to achieve LDL-C goals; nu rse management (P =.09) was marginally significant. Pharmacotherapy wa s instituted in 45.2% of NURS and 16.7% of EPC siblings (P =.001). Con clusions: High LDL-C levels in siblings were more effectively treated by a trained nurse, probably related to greater adherence to the appli cation of national guidelines. Nonetheless, the majority of siblings w ith high LDL-C levels did not meet goal levels 2 years after an index case coronary heart disease event.