ORLANDO, FLA. — Giving patients with diabetes printed reports with individualized cardiovascular risk profiles helped the patients improve their cholesterol levels in a randomized study.
“It's like a report card. It makes a difference when you present information visually and you discuss it—shared decision making is more effective,” Ilka Lowensteyn, Ph.D., said during a poster presentation at the annual scientific sessions of the American Diabetes Association.
Patients with diabetes from 230 primary care offices were randomized to receive printed, individualized risk profiles (691 participants) or usual care (697 participants). Each one-page report included a bar graph showing the patient's 10-year risk of cardiovascular disease based on Framingham equations, as well as the estimated benefits of risk factor reduction. The report also includes a table that calculates cardiovascular age based on risk factors.
Patients can easily see how a reduction in each risk factor translates to years of life saved, said Dr. Lowensteyn, director of clinical research, Arcadie Health Assessment Associates Inc., Montreal.
“It's very impressive for patients. And it allows physicians to get a 'buy-in' from patients,” he said. An individual profile might show that a patient with diabetes needs to change three things: smoking, cholesterol, and lipids. A physician discussing the risk profile could then ask, “Which one do you want to tackle first?” he said.
The participants, aged 30-70 years, were demographically similar between the two groups.
Exercise and dietary changes were prescribed for 3 months if cardiovascular risk was moderate at baseline, and could be continued thereafter if risk did not increase.
Patients were eligible for statin treatment if their LDL cholesterol level was 100 mg/dL or more or their total cholesterol/HDL cholesterol ratio was 4 or greater.
Physicians were free to prescribe any statin and patients were responsible for filling the prescription, so the study was a relatively real-world assessment compared with a clinical trial. The study was sponsored and jointly developed by Pfizer Canada Inc.
Profiles were updated every 3 months for up to 1 year, providing participants in the intervention group with regular feedback and trend data regarding their efforts to reduce risk factors.
“The big impact was on cholesterol,” Dr. Lowensteyn said. After 12 months of statin therapy, patients in the risk profile group had significantly greater reductions in total cholesterol (26.3%, vs. 23.8% with usual care), LDL cholesterol (36.6%, vs. 33.6% with usual care), total cholesterol/HDL cholesterol ratio (27.2%, vs. 24.9% with usual care), and projected 10-year cardiovascular disease risk (33.8%, vs. 30.8% with usual care).
Cardiovascular risk profiles are worthwhile even if they confer only a modest improvement in statin compliance among diabetic patients, Dr. Lowensteyn said. “Even if it's an extra 10% still on medication at the end of the year, that is great.”