Achieving national cholesterol education program goals for low-density lipoprotein cholesterol in cardiac patients: Importance of diet, exercise, weight control, and drug therapy

Objective: To determine how frequently the National Cholesterol Education P rogram (NCEP) goal of a low-density lipoprotein (LDL) cholesterol level of 100 mg/dL or less is achieved in clinical practice in patients with coronar y artery disease and what fraction of patients can achieve this goal withou t drug therapy. Design: We examined the results of lipid management in 152 consecutive pati ents who had completed cardiac rehabilitation after an acute coronary event . Patients were randomized to follow-up by specially trained nurses or by p reventive cardiologists, and they were not receiving lipid-lowering drugs a t the start of the study, Material and Methods: Patients were given aggressive diet and exercise reco mmendations and lipid-lowering drugs in accordance with NCEP guidelines. Fo llow-up was continued for a mean of 526 days after the first lipid assessme nt subsequent to the coronary event, Multiple logistic regression analysis was used to identify independent predictors of a final LDL cholesterol leve l of 100 mg/dL or less. Results: Of the study group,39% achieved the NCEP goal LDL cholesterol leve l of 100 mg/dL or less. Characteristics of the patients with LDL cholestero l levels of 100 mg/dL or less in comparison with those with LDL cholesterol levels of more than 100 mg/dL included a greater frequency of drug therapy (65% versus 38%), more rigorous dietary compliance, longer follow-up (586 +/- 317 days versus 493 +/- 264 days), more favorable weight change (-0.3 /- 4.9 kg versus +1.7 +/- 5.0 kg), and more extensive weekly exercise (183 +/- 118 minutes versus 127 +/- 107 minutes). Conclusion: The registered nurses managed the lipids of these patients as e ffectively as did the preventive cardiologists. Appropriate drug therapy wa s the most important factor in achieving an LDL cholesterol level of 100 mg /dL or less, but 35% of patients attaining this NCEP goal were not receivin g drug therapy. Exercise, dietary compliance, and weight loss were also imp ortant factors.