Hyperlipidaemia management after primary coronary artery bypass surgery: A survey of patients and general practitioners

Abstract

Background: It is well established that, in patients with increased cholesterol concentrations and vascular disease decreasing the cholesterol concentration significantly reduces the risk of coronary events. After coronary artery bypass graft surgery (CABG), the risk of further coronary events is likely to be reduced if there is effective control of cholesterol concentrations. The aim of the survey was to review awareness among general practitioners and patients of the need for maintenance of serum cholesterol values, frequency of serum cholesterol checks, dietary advice and lipid- decreasing medication in patients after CABG. Methods: Hospital notes of 200 patients who underwent primary, coronary artery bypass surgery from January 1994 to 1996 were examined and postal questionnaires sent to patients and their general practitioners inquiring whether they had had their serum cholesterol tested in the past 3 years; whether dietary advice had been given if cholesterol concentrations were increased to more than 5.2 mmol/l; whether a repeat serum cholesterol test was performed 3 months later if values were greater than 5.2 mmol/l; and (for those with serum cholesterol values greater than 5.2 mmol/l), whether they were on lipid-decreasing medication. Results: We considered 146 (76%) replies to be complete. Hospital and general practitioner records of these patients showed, that in the previous 3 years, after CABG, only 63% (n = 92) had their serum lipid profile checked and, of these, 74% (n = 68) had increased serum cholesterol concentrations of more than 5.2 mmol/l. Only 46% (n = 31) received dietary advice alone. After dietary advice had been given, serum cholesterol was rechecked in 26% (n = 8) of patients and only 3% (n = 1) had a decrease in serum cholesterol to less than 5.2 mmol/l. Among the patients with increased serum cholesterol, 50% (n = 34) received lipid-decreasing medication but serum cholesterol was rechecked in only 52% (n = 17) of patients. In 9% (n = 3) of these, serum cholesterol concentrations had decreased to less than 5.2 mmol/l. Among the 146 complete replies from patients, 95% (n = 139) indicated that control of serum cholesterol was important, 82% (n = 120) had received dietary advice and 39% (n = 57) were on lipid-decreasing medication. Conclusion: General practitioners and patients were generally aware of cholesterol control after CABG. However, a relatively low proportion of patients underwent serum cholesterol checks and received documented dietary advice, lipid-decreasing medication, or both. Dietary advice alone may be inadequate in controlling lipid concentrations and, in many cases, needed to be supplemented with adequate lipid-decreasing therapy.