Activating peripheral arterial disease patients to reduce cholesterol: a randomized trial

Mary McGrae McDermott, Northwestern University
George W. Reed, University of Massachusetts Medical School
Philip Greenland, Northwestern University
Kathleen M. Mazor, University of Massachusetts Medical School
Sherry L. Pagoto, University of Massachusetts Medical School
Judith K. Ockene, University of Massachusetts Medical School
Rex Graff, Northwestern University
Philip A. Merriam, University of Massachusetts Medical School
Katherine Leung, University of Massachusetts Medical School
Larry Manheim, Northwestern University Feinberg School of Medicine
Melina R. Kibbe, Jesse Brown Veterans Administration Medical Center
Barbara C. Olendzki, University of Massachusetts Medical School
William H. Pearce, Northwestern University Feinberg School of Medicine
Ira S. Ockene, University of Massachusetts Medical School

Abstract

BACKGROUND: Peripheral arterial disease patients are less likely than other high-risk patients to achieve ideal low-density lipoprotein (LDL) cholesterol levels. This randomized controlled trial assessed whether a telephone counseling intervention, designed to help peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician, achieved lower LDL cholesterol levels than 2 control conditions.

METHODS: There were 355 peripheral arterial disease participants with baseline LDL cholesterol >/=70 mg/dL enrolled. The primary outcome was change in LDL cholesterol level at 12-month follow-up. There were 3 parallel arms: telephone counseling intervention, attention control condition, and usual care. The intervention consisted of patient-centered counseling, delivered every 6 weeks, encouraging participants to request increases in cholesterol-lowering therapy from their physician. The attention control condition consisted of telephone calls every 6 weeks providing information only. The usual care condition participated in baseline and follow-up testing.

RESULTS: At 12-month follow-up, participants in the intervention improved their LDL cholesterol level, compared with those in attention control (-18.4 mg/dL vs -6.8 mg/dL, P=.010) but not compared with those in usual care (-18.4 mg/dL vs -11.1 mg/dL, P=.208). Intervention participants were more likely to start a cholesterol-lowering medication or increase their cholesterol-lowering medication dose than those in the attention control (54% vs 18%, P=.001) and usual care (54% vs 31%, P <.001) conditions.

CONCLUSION: Telephone counseling that helped peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician achieved greater LDL cholesterol decreases than an attention control arm that provided health information alone.