Nurse-mediated cholesterol management compared with enhanced primary care in siblings of individuals with premature coronary disease

Arch Intern Med. 1998 Jul 27;158(14):1533-9. doi: 10.1001/archinte.158.14.1533.


Background: Siblings of individuals with premature coronary heart disease have a high prevalence of low-density lipoprotein cholesterol (LDL-C) levels requiring treatment.

Objective: To evaluate management strategies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior to age 60 years.

Methods: In a 2-year trial of care provided by either a nurse trained in lipid management (NURS) or enhanced primary care (EPC), in which physicians received recommendations based on national guidelines, 156 siblings with LDL-C levels of 4.14 mmol/L (160 mg/dL) were randomized by family. The LDL-C goal levels below 3.36 mmol/L (130 mg/dL) were compared between and within intervention groups. Multiple logistic regression analyses were applied to predict 2-year achievement of the goal.

Results: The NURS group achieved a significantly greater percentage of goal LDL-C levels than the EPC group (26% vs 10%; P=.008). The NURS LDL-C levels decreased an average of 0.91 mmol/L (35 mg/dL) while EPC levels decreased by 0.52 mmol/L (24 mg/dL) (P=.09). In the final multivariate model, siblings taking lipid-lowering drug treatment were 6.02 times more likely (95% confidence interval, 2.24-16.18) than those not receiving pharmacotherapy to achieve LDL-C goals; nurse management (P=.09) was marginally significant. Pharmacotherapy was instituted in 45.2% of NURS and 16.7% of EPC siblings (P=.001).

Conclusions: High LDL-C levels in siblings were more effectively treated by a trained nurse, probably related to greater adherence to the application of national guidelines. Nonetheless, the majority of siblings with high LDL-C levels did not meet goal levels 2 years after an index case coronary heart disease event.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cholesterol, LDL / blood
  • Coronary Disease / genetics*
  • Coronary Disease / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercholesterolemia / blood
  • Hypercholesterolemia / diet therapy
  • Hypercholesterolemia / drug therapy
  • Hypercholesterolemia / genetics
  • Hypercholesterolemia / nursing*
  • Hypercholesterolemia / therapy*
  • Logistic Models
  • Male
  • Maryland
  • Middle Aged
  • Nursing Care*
  • Primary Health Care*
  • Treatment Outcome


  • Cholesterol, LDL