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The CHECK-UP Study: A Randomized Controlled Trial

Steven A. Grover, MD, MPA, FRCPC; Ilka Lowensteyn, PhD; Lawrence Joseph, PhD; Mohammed Kaouache, MSc; Sylvie Marchand, RN; Louis Coupal, MSc; Ghislain Boudreau, PhD; for the Cardiovascular Health Evaluation to Improve Compliance and Knowledge Among Uninformed Patients (CHECK-UP) Study Group

Arch Intern Med. 2007;167(21):2296-2303.

Background  Despite increasing evidence that treating dyslipidemia reduces cardiovascular events, many patients do not achieve recommended lipid targets.

Methods  To determine whether showing physicians and patients the patient's calculated coronary risk can improve the effectiveness of treating dyslipidemia in a primary care setting, patients were randomized to receive usual care or ongoing feedback regarding their calculated coronary risk and the change in this risk after lifestyle changes, pharmacotherapy, or both to treat dyslipidemia. Outcomes, based on intention-to-treat analysis, included changes in blood lipid levels, coronary risk, and the frequency of reaching lipid targets.

Results  Two hundred thirty primary care physicians enrolled 3053 patients. After 12 months of follow-up, 2687 patients (88.0%) remained in the study. After adjustment for baseline lipid values, significantly greater mean reductions in low-density lipoprotein cholesterol levels and the total cholesterol to high-density lipoprotein cholesterol ratio were observed in patients receiving risk profiles (51.2 mg/dL [to convert to millimoles per liter, multiply by 0.0259] and 1.5, respectively) vs usual care (48.0 mg/dL and 1.3, respectively), but the differences were small (–3.3 mg/dL; 95% confidence interval [CI], –5.4 to –1.1 mg/dL; and –0.1; 95% CI, –0.2 to –0.1, respectively). Patients in the risk profile group were also more likely to reach lipid targets (odds ratio, 1.26; 95% CI, 1.07 to 1.48). A significant dose-response effect was also noted when the impact of the risk profile was stronger in those with worse profiles.

Conclusions  Discussing coronary risk with the patient is associated with a small but measurable improvement in the efficacy of lipid therapy. The value of incorporating risk assessment in preventive care should be further evaluated.

Author Affiliations: McGill Cardiovascular Health Improvement Program and the Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Departments of Medicine and Epidemiology and Biostatistics, McGill University (Drs Grover, Lowensteyn, and Joseph; Messrs Kaouache and Coupal; and Ms Marchand), and Pfizer Canada (Dr Boudreau), Montreal, Quebec, Canada.

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