ArticleKansas journal of medicine
Descriptive Evaluation in Outpatient Follow-Up of Direct LDL-C in Patients with Elevated Triglycerides and Diabetes.
Article in Kansas journal of medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Introduction: An annual fasting lipid panel (FLP) is recommended for patients with diabetes, with more frequent testing advised during the escalation of cholesterol-lowering therapy. However, the calculated low-density lipoprotein cholesterol (LDL-C) using the Friedewald equation becomes unreliable when triglycerides are ≥400 mg/dL. In such cases, providers must order a separate direct LDL-C assay to obtain accurate results. Failing to do so may lead to missed opportunities for therapy intensification. This study examined an institution's current practices for following up on invalid LDL-C results, especially considering the stringent LDL-C targets outlined in recent guidelines and consensus statements. Methods: The authors conducted a retrospective chart review across 13 outpatient clinics within a single health system over five years. The study included patients aged 40-75 with diabetes who had at least one invalid LDL-C result. They assessed the frequency of ordering a direct LDL-C assay within seven days of an invalid LDL-C result. Results: Out of 1,364 unique invalid FLPs, 97 (7.1%) met the criteria for the primary outcome. The rate of therapy escalation was not numerically affected by whether a direct LDL-C was ordered or the provider type. However, patients without a direct LDL-C ordered within seven days showed a trend towards more frequent therapy escalation (16.2%, n = 25/154) compared to those with a direct LDL-C (14.9%, n = 23/154). Conclusions: The current practice at this institution of manually ordering a direct LDL-C assay to verify invalid LDL-C results poses a risk of missing necessary guideline-directed therapeutic intensification. This process may be improved by implementing a reflex direct LDL-C assay.
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