Long-term effects on cholesterol levels and the utilization of lipid-lowering drugs of a hospital-based programme for secondary prevention of coronary artery disease

Background The study was designed to determine whether a 1-year hospital-ba sed secondary prevention programme would have any long-term effects on seru m lipid levels and the use of lipid-lowering drugs in patients with coronar y artery disease 4 years after referral to primary care facilities for foll ow-tip. Design/methods After acute myocardial infarction or coronary bypass surgery , 241 consecutive patients were randomly assigned to conventional care (CC) by the primary health care facilities or to a 1-year hospital-based second ary prevention programme (SPP) with target levels for serum cholesterol (<5 .2 mmol/l) and triglycerides (<1.5 mmol/l). After 1 year all patients were referred to the primary care sector for a further 4-year follow-up. Results At the 1-year follow-up there was a significant decrease in serum c holesterol, LDL-cholesterol and triglyceride levels in the SPP group but no change in the CC group, and lipid-lowering drugs were used more frequently in the SPP group. These changes were maintained after 5 years. The proport ion of patients achieving target serum cholesterol and triglyceride levels were larger in the SPP group. Conclusions Initiatives regarding cholesterol lowering and drug treatment t aken by specialists within a structured hospital-based SPP have long-term i mpact. Accordingly, drug treatment should be initiated and adjusted to adeq uate doses before patients are referred to primary care for follow-up. J Ca rdiovasc Risk 8:243-248 (C) 2001 Lippincott Williams & Wilkins.