Treatment of Hypercholesterolemia by a Clinical Nurse Using a Stepped-Care Protocol in a Nonvolunteer Population

Abstract

National trials have demonstrated that the incidence of myocardial infarction and coronary death can be decreased, and progression of atherosclerosis delayed or reversed, by administration of bile acid-binding resins. A cholesterol clinic was established to determine whether a simple protocol would be effective in a nonvolunteer population referred by practicing cardiologists. The clinic was operated by a nurse who followed a stepped-care protocol, similar in concept to that used for treatment of hypertension. In the treatment of 86 patients with type II hyperlipidemia (cholesterol level, greater than 6.85 mmol/L [greater than 265 mg/dL]; triglyceride levels, normal or mildly elevated), compliance with the protocol resulted in reductions in cholesterol level of 19% in patients treated with diet, 23% for those treated with diet plus a bile sequestrant (colestipol hydrochloride or cholestyramine resin), and 25% in those treated with diet plus other cholesterol-lowering drugs. This method of treatment was effective and may serve as a model for the management of large numbers of patients with this condition.