Increasing physician monitoring of patients with high cholesterol is associated with progressive reductions in total cholesterol, triglyceride levels, and low-density lipoprotein cholesterol (LDL-C) concentrations, according to study results published in Preventive Medicine.
A total of 97,548 men and 110,424 women who had blood sent to Boston Heart Diagnostics for analysis between 2010 and 2017 were included in the analysis. The researchers calculated differences in total cholesterol, triglycerides, and LDL-C from baseline and follow-up visits.
Adjusted analyses examined whether patients with an initial diagnosis of high total cholesterol (≥240 mg/dL), high to very high triglycerides (≥200 mg/dL), and high to very high LDL-C (≥160 mg/dL) experienced improvements in these variables with increased physician monitoring. In addition, the investigators estimated reductions “in cholesterol and triglycerides by the number of follow-up visits when adjusted for baseline age and the duration of follow-up.”
In the adjusted analysis, the respective changes in plasma concentrations according to each follow-up in men and women were −2.84±0.10 mg/dL and −3.03±0.10 mg/dL for total cholesterol, −3.78±0.30 mg/dL and −2.26±0.19 mg/dL for triglycerides, and −2.54±0.09 mg/dL and −3.06±0.09 mg/dL for LDL-cholesterol (all P <10−16).
Reductions were found at the first, second, and third follow-up assessments for total cholesterol (mean, men: −9.4±0.1, −11.9±0.2, −13.7±0.3; women: −8.0±0.1, −10.5±0.2, −12.6±0.3 mg/dL, respectively; P <10−16), triglycerides (men: −10.3±0.4, −12.8±0.5, −13.4±0.7; women: −6.4±0.2, −8.8±0.4, −10.1±0.5 mg/dL, respectively; P <10−16), as well as LDL-C (men: −7.8±0.1, −9.9±0.2, −11.1±0.2; women: −6.9±0.1, −9.0±0.2, −10.7±0.2 mg/dL, respectively; P <10−16).
Up to 6.9%, 9.9%, and 11.8% of men and 5.7%, 9.7% and 11.5% of women had an LDL-C of ≥160 to <160 mg/dL for the first, second, and third follow-up assessment, respectively.
Limitations of the study included the lack of data on providers’ healthcare priorities and their aggressiveness in treatment protocols.
“Although we cannot exclude the possibility that patients who are more successful at controlling [LDL-C] self-select for more frequent follow-up, our results are consistent with the more tenable hypothesis that under usual physician care, improvements in lipids and lipoproteins are in accordance with the level of physician monitoring,” the researchers wrote. “The lipid improvements associated with greater follow-up testing needs to be considered before characterizing repeat cholesterol testing as overuse.”
Dansinger ML, Williams PT, Superko HR, Schaefer EJ. The importance of cholesterol follow-up testing under current statin treatment guidelines. Prev Med. 2019;121:150-157.