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Practice Patterns in Treating High-Risk Patients with Hyperlipidemia at a Northeast Tennessee University Clinic
  1. Hassan M. Ismail,
  2. Christina Simmons,
  3. Deborah Pfortmiller
  1. From the Department of Internal Medicine (H.M.I., C.S., D. P.), East Tennessee State University/James Quillen College of Medicine, Johnson City, TN.
  1. Address correspondence to: Hassan M. Ismail, MD, MPH, Department of Internal Medicine, East Tennessee State University/James Quillen College of Medicine, 325 N. State of Franklin Road, 2nd Floor, Johnson City, TN 37604; e-mail: ismail{at}


Background This study was conducted to test the hypothesis that internal medicine residents at a northeast Tennessee university clinic were not compliant with the latest National Cholesterol Educational Program Adult Treatment Panel (NCEP-ATP) guidelines in treating hyperlipidemia in patients with diabetes and coronary artery disease.

Methods A retrospective medical record survey was conducted to evaluate residents' pattern in lowering low-density lipoprotein (LDL) cholesterol to below 100 mg/dL in patients with diabetes and coronary artery disease. The survey covered a 5-year period, from July 1998 to June 2003, and included 15 randomly chosen residents who were in training for 3 consecutive years. Charts were randomly selected from residents' clinics using International Classification of Diseases-9 codes for coronary artery disease or diabetes mellitus with hyperlipidemia. Five hundred fifty charts were reviewed. Only 41 (7.45%) met the inclusion criteria.

Results Analysis of data using Epi-Info 2002 (Centers for Disease Control and Prevention, Atlanta, GA) revealed that only 68.3% of patients with diabetes and coronary artery disease reached target LDL cholesterol levels. Of the patients who reached target levels, only 42.9% maintained them. Analysis of variance and chi-square tests revealed that the frequency of cholesterol measurement, but not the frequency of physicians' visits, was associated with a higher likelihood of reaching the target LDL level.

Conclusion There was a suboptimal compliance among internal medicine residents in the frequency of screening for, reaching, and maintaining the target LDL cholesterol level, according to the latest NCEP-ATP guidelines, among high-risk patients with hyperlipidemias.

  • National Cholesterol Educational Program Adult Treatment Panel
  • low-density lipoprotein
  • coronary artery disease
  • diabetes mellitus
  • impaired fasting glucose
  • target LDL level
  • statins
  • ezetimibe
  • American Diabetes Association
  • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
  • World Health Organization
  • Global Registry of Acute Coronary Events
  • reversal of atherosclerosis with aggressive lipid lowering
  • pravastatin or atorvastatin evaluation and intensive therapy

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