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Diane M. Becker, RN, ScD, MPH; Judith V. Raqueño, RN, BSN; Raphael M. Yook, MSPH; Brian G. Kral, BA; Roger S. Blumenthal, MD; Taryn F. Moy, RD, MS; Pamela J. Bezirdjian, RN, MPH; Lewis C. Becker, MD

Arch Intern Med. 1998;158:1533-1539.

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.

From the Center for Health Promotion (Dr D. M. Becker, Mss Raqueño, Moy, and Bezirdjian, and Mr Yook) and the Division of Cardiology (Drs Blumenthal and L. C. Becker and Mr Kral), The Johns Hopkins University, Baltimore, Md.

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