Journal of Clinical Lipidology
Volume 6, Issue 1 , Pages 50-57, January 2012

Non–high-density lipoprotein cholesterol calculation and goal awareness among physicians-in-training

  • Smita I. Negi, MD

      Affiliations

    • Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    • Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    • ,
  • Lynne Steinberg, PhD

      Affiliations

    • University of Houston, Houston, TX, USA
    • ,
  • Venkateshwar R. Polsani, MD

      Affiliations

    • Tulane Heart and Vascular Center, New Orleans, LA, USA
    • ,
  • Saqib A. Gowani, MD

      Affiliations

    • University of Connecticut, Farmington, CT, USA
    • ,
  • Vijay Nambi, MD

      Affiliations

    • Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    • Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    • ,
  • Varinder Kumar, MD

      Affiliations

    • University of Vermont, Burlington, VT, USA
    • ,
  • Victor Marinescu, MD, PhD

      Affiliations

    • William Beaumont Hospital, Detroit, MI, USA
    • ,
  • Peter H. Jones, MD

      Affiliations

    • Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    • Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    • ,
  • Laura A. Petersen, MD, MPH, FACP

      Affiliations

    • Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Health Services Research and Development Center of Excellence, Section of Health Services, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
    • ,
  • Christie M. Ballantyne, MD

      Affiliations

    • Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    • Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    • ,
  • Salim S. Virani, MD

      Affiliations

    • Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
    • Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
    • Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Health Services Research and Development Center of Excellence, Section of Health Services, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
    • Corresponding Author InformationCorresponding author.

Received 28 June 2011; accepted 31 October 2011. published online 09 November 2011.

Background

Non-high density lipoprotein cholesterol (non-HDL-C) goal attainment per Adult Treatment Panel III (ATP III) guidelines remains low.

Objective

To understand gaps in knowledge and practices of physicians-in-training (internal medicine, family medicine, cardiology, endocrinology) towards non-HDL-C.

Methods

A survey based on a conceptual model to assess the trainee’s knowledge, attitudes, and practice regarding non-HDL-C was developed and administered to physicians-in-training (n = 655) at 26 training programs in the United States. Responses of those in internal medicine and family medicine (residents-in-training; n = 418) were compared with those in cardiology and endocrinology (fellows-in-training; n = 124).

Results

Response rate was 83.7%. Fifty-three percent of residents and 31% of fellows-in-training had not read the ATP III guidelines (P < .001). Thirty-three percent of the residents and 35% fellows-in-training could not calculate non-HDL-C from a standard lipid panel (P = .7). Sixty-seven percent of the residents and 52% of fellows were not aware of treatment goals for non-HDL-C (P = .004 for comparison between residents and fellows). Both residents and fellows reported infrequent calculation of non-HDL-C levels in patients with elevated triglycerides (≥200 mg/dL; 32.5% vs 35.4%, respectively, P = .6). Lack of familiarity with ATP III guidelines, lack of knowledge regarding importance of non-HDL-C, lack of institutional mandate to calculate non-HDL-C, and lack of emphasis on non-HDL-C by teaching staff were reported as barriers to non-HDL-C use in routine clinical practice.

Conclusions

At least one-third of physicians-in-training could not calculate non-HDL-C from a standard lipid panel, and a large number were not aware of ATP III treatment goals pertaining to non-HDL-C. This area represents one for improvement if non-HDL-C is to be retained as a treatment target in the forthcoming ATP-IV guidelines.

Keywords: Adult Treatment Panel guidelines, Non-HDL-C calculation, Non-HDL-C goals, Physicians-in-training

 

PII: S1933-2874(11)00799-9

doi:10.1016/j.jacl.2011.10.020

Journal of Clinical Lipidology
Volume 6, Issue 1 , Pages 50-57, January 2012

Article Tools

* Image Usage & Resolution