Practice News / Events

Anatomy of a Lipid Clinic
By Robyn Reynolds, RD, LD

No doubt you’ve heard this sobering statistic before: cardiovascular disease, or CVD, is the number one cause of death in the United States. According to the American Heart Association, CVD kills more Americans than cancer, lung disease, diabetes, and accidents combined. The Centers for Disease Control estimates that approximately 22 million people in the United States currently have heart disease. While some risk factors for CVD, like age, gender, and family history, cannot be changed, one major risk factor can: hyperlipidemia, or high cholesterol.

The solution seems easy: a blood test is performed, the patient is diagnosed with hyperlipidemia, a lipid-lowering medication is prescribed, and a healthy lifestyle is initiated that includes diet and exercise. However, according to data from the National Cholesterol Education Program (NCEP), less than 50% of Americans with high cholesterol are receiving any kind of treatment to lower it and reduce the risk of CVD. Furthermore, less than half of patients with known CVD are getting lipid-lowering treatment. So it’s not surprising to learn that of those patients being treated for hyperlipidemia, less than a third are achieving their LDL (“bad” cholesterol) goal. While studies have revealed that diet and exercise alone can produce modest improvements in lipid levels, far greater success has been achieved with lipid lowering medications, especially statins such as Lipitor or Zocor. Optimal treatment should include diet, exercise, and medication therapy to help more patients achieve their cholesterol goals and thus reduce the risk and incidence CVD. This treatment may soon be available at Heart Clinic Arkansas’ Lipid Clinic. The primary goal of the Lipid Clinic is to reduce the risk and occurrence of CVD through regular testing and disease management of patients with or at risk of hyperlipidemia and/or CVD. To achieve this, four procedures must be performed at each patient visit: lipid testing, lifestyle counseling, medication adjusting, and followup appointment scheduling. These actions work together to facilitate patient compliance with their medication and lifestyle prescription and hopefully improve individual outcomes.

Let’s examine each procedure in detail. The first step in treating high cholesterol is through proper screening, or testing. At each Lipid Clinic visit, the Med Tech will draw blood and perform a lipid panel. At Heart Clinic Arkansas, the Cholestech system is used for measuring blood cholesterol. Instead of drawing blood out the arm, the patient’s finger is pricked and a small amount of blood is drawn out with a capillary tube. The blood is placed on a slide designed specifically for the Cholestech machine. Results are ready in about 5-7 minutes. The lipid panel measures: After the lipid panel is done, the patient is ready for the next step: lifestyle counseling. The patient meets with a Registered Dietitian (RD), who reviews the lipid panel results and goals with the patient. An evaluation is done by the RD assessing the patient’s diet, exercise habits, alcohol and tobacco use, and frequency of dining out. Stress management may also be addressed if the patient indicates this is a factor in compliance. After the evaluation, the RD will identify those areas where changes should be made, set goals with the patient, and outline how to achieve those goals. Educational materials are also provided. An important part of controlling high cholesterol is medication. After lipid testing and lifestyle counseling are completed, the RD will discuss lipid-lowering medications and related issues such as side effects and proper dosing.

The most common lipid-lowering drugs used are the statins, such as Lipitor, Zocor, or Crestor. Nicotinic acid and fibric acids are also widely used with or instead of the statins. The results of the lipid profile are sent to the patient’s physician (MD), who makes the appropriate medication changes based on lab results and patient tolerance. The MD then relays these changes to the RD, who will then communicate that to the patient. Finally, after the Lipid Clinic visit is complete, a follow-up appointment is made. Following up with the patient is important for many reasons. First, it encourages compliance with lifestyle and medication changes. Second, it is crucial to monitor not only blood cholesterol but also liver enzymes, as many lipid lowering medications can adversely affect the liver. Side effects with medications should also be addressed on a regular basis. Lastly, follow-up appointments allow the patient and practitioner to develop a relationship that may significantly improve patient outcomes. Follow-ups may be scheduled anywhere from 1 month to 6 months, based on factors such as recent medication changes, lifestyle compliance, and achievement of cholesterol goals. Lipid Clinic can be an effective tool in managing risk factors for CVD. Not only does management include achieving blood cholesterol goals, but also weight loss, blood sugar control for diabetics, smoking cessation, and adherence to diet and exercise. If you have a patient, or if you are a patient, who would benefit from this service, call (501) 255-6854 for more information.