Discussion of coronary risk profiles between physicians and patients may help improve long-term patient compliance and resulting response rates for management of cholesterol levels, according to an article in the November 26 issue of Archives of Internal Medicine.

Treatment for dyslipidemia is most effective when targeted to high-risk individuals, according to background information in the article. However, these patients sometimes do not adhere to recommended lifestyle changes or pharmacotherapy. One study suggested that one third of patients who discontinue lipid-lowering medications do so because they are not convinced they need treatment.

Steven A. Grover, MD, of McGill University, Montreal, Quebec, Canada, and colleagues followed 3,053 patients undergoing treatment for dyslipidemia with lifestyle changes and statin medications as needed. A group of 1,510 patients was randomized to receive an additional one-page computer printout of their probability for developing heart disease at the beginning of the study and at follow-up visits 3, 6, 9 and 12 months later.

A total of 2,687 patients completed the 12-month study. After adjusting for baseline cholesterol levels, individuals who received their risk profile had small but significantly greater reductions in their low-density lipoprotein cholesterol level and total cholesterol to high-density lipoprotein cholesterol ratio.

"Patients in the risk profile group were also more likely to reach lipid targets," the authors wrote.

The risk profile included a summary of each individual's cardiovascular age, calculated by subtracting the difference between life expectancy and the average life expectancy from the individual's current age. "For example, a 50-year-old with a life expectancy of 25 more years (versus 30 more years for the average Canadian) would be assigned a cardiovascular age of 55 years," the authors wrote. "Individuals without cardiovascular disease were also given their cardiovascular age, their actual age and the resulting ‘age gap' (cardiovascular age minus actual age). This variable seemed to modify the degree to which patients responded to the risk profile."

Patients with a larger gap between their cardiovascular and actual age had greater reductions in low-density lipoprotein cholesterol levels than those with a smaller gap or no gap.

Given the public health burden of cardiovascular disease, preventive steps must be taken, the authors noted. "Communicating risk is consistent with many of the recommendations to improve adherence, including enhancing self-monitoring and using the support of family and friends," the authors concluded. "Informing patients of their coronary risk may also increase the effectiveness of primary prevention by identifying individuals most likely to benefit from treatment while reassuring those at low risk. This information may also assist physicians in treatment selection while improving patient adherence."