Abstract 3308: The Sustained Impact of a Community-based Risk Factor Reduction Program on LDL Cholesterol Goals in a High Risk African American Population
Background: Siblings (SIBS) of people with premature coronary heart disease (CHD) have a high prevalence of both CHD and elevated LDL-cholesterol (LDL-C).
Objective: To determine the sustainability of 1-year of community based care (CBC) by a nurse practitioner and community health educator team compared with enhanced usual care (EUC) designed to remove barriers to the treatment of LDL-C, we screened 259 apparently healthy African American SIBS (30–59 years old; 63% female; mean age 47 ± 7yrs) and randomized them by family to CBC or EUC.
Methods: All SIBS had LDL-C levels and lipid-lowering medication use (MEDS) measured at baseline, 1-year, and 5-years post-intervention. Comparisons were made between the percentage of SIBS at LDL-C goal (<130mg/dl) and on MEDS both within and between groups from baseline to 1- and 5-years of follow-up.
Results: At baseline, the CBC and EUC groups had similar mean LDL-C levels (140± 37 and 136 ± 39mg/dl, respectively) but significantly more people in the EUC group were on MEDS (3.6 vs. 9.3). At 1-year follow-up there was a significant difference between groups in the percent with LDL-C at goal (p<0.0001), but no significant difference was observed between groups at 5-years (p= 0.44). Both the CBC and EUC groups showed a substantial increase in the percent at goal LDL-C between baseline and 5-years (+26% and +20%, respectively) as well as in the percent taking MEDS (+32% and +16%, respectively; p=0.06 between groups).
Conclusion: At 5-years, the impact of the CBC intervention in achieving goal LDL-C levels and maintaining adherence to lipid lowering therapy is less than that seen at 1 year, but a modest benefit is preserved with respect to both outcomes.