This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mcgowan, N. Articles by Mcknight, J. A Search for Related Content Social Bookmarking                         What's this?

Initial and sustained cardiovascular risk reduction in a pharmacist-led diabetes cardiovascular risk clinic

Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland

Alison Cockburn

Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland

Mark Wj Strachan

Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland

Paul L Padfield

Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland

John A Mcknight

Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, John.McKnight{at}luht.scot.nhs.uk

Background

The atherogenic milieu of hypertension, hyperglycaemia and dyslipidaemia results in an excess of cardiovascular deaths in the diabetic population.

Objective

To determine the efficacy and long-term success of a pharmacist-delivered cardiovascular risk reduction clinic.

Methods

Patients with diabetes not achieving blood pressure (BP) and lipid targets at a standard diabetes clinic had a mean of four visits to the pharmacist-delivered clinic.

Results

BP was significantly reduced by attending the clinic (mean reduction in clinic BP 23/10 mmHg). Ambulatory BP monitoring demonstrated a mean reduction of 13/9 mmHg from clinic entry to discharge and this effect was sustained six months post-discharge .

Total cholesterol was reduced by 0.4 mmol/L (p=0.002) during clinic attendances and remained unchanged post discharge.

Conclusion

Patients previously thought to be `resistant' to treatment can have significant reductions in cardiovascular risk factors when enrolled in a short-lived, intense clinic set-up. This is maintained

Key Words: cardiovascular risk • diabetes • hypertension

References

• Huxley R., Barzi F., Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006;332:73-8.[Abstract/Free Full Text]
• Booth GL, Kapral MK, Fung K., Tu JV Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population based retrospective cohort study. Lancet 2006;368:29-35.[CrossRef][Medline] [Order article via Infotrieve]
• Turner R., Holman R., Stratton I. et al. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes:UKPDS 38. BMJ 1998;317:703-12.[Abstract/Free Full Text]
• Hansson L., Zanchetti A., Carruthers SG et al. Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998;351:1755-62.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Collins R., Armitage J., Parish S., Sleigh O., Petro R. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003;361:2005-16.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Colhoun HM, Betteridge DJ, Durrington PN et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controllled trial. Lancet 2004;364:685-96.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Eliasson B., Cederholm J., Nilsson P., Gudbjonsdottir S. The gap between guidelines and reality: Type 2 diabetes in a national diabetes register 1996-2003. Diabet Med 2005;22:1420-26.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Graede P., Vedel P., Larsen N. et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:343-94.
• Donnan PT, MacDonald TM, Morris AD Adherence to prescribed oral hypoglycaemic medication in a population of patients with type 2 diabetes: A retrospective cohort study. Diabet Med 2002;19:279-84.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Halpern MT, Khan ZM, Schmier JK et al. Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension 2006;47:1039-48.[Free Full Text]
• Pickering TG, Hall JE, Appel LJ et al. Recommendations for Blood Pressure measurement in Human and experimental animals: Part 1: Blood pressure measurement in Humans: A statement for professionals from the subcommittee of professional and public education of the American Heart Association council on high blood pressure research. Circulation 2005;111:697-716.[Abstract/Free Full Text]
• Williams B., Poulter NR, Brown MJ et al. Guidelines for the management of hypertension. Report of the fourth working party of the British Society of hypertension. J Hum Hypertens 2004;18:139-85.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dawes MG, Coats AJ, Juszczak E. Daytime ambulatory blood pressure is better at predicting mortality than clinic blood pressure. Blood Press Monit 2006;11:111-18.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dolan E., Stanton A., Thijs L. et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 2005;46:156-61.[Abstract/Free Full Text]
• Lowey A., Moore S., Norris C., Wright D., Silcock J., Hammond P. The cost effectiveness of pharmacist-led treatment of cardiac risk in type 2 diabetes. Pharm World Sci 2007 March 30 - EPUB ahead of print.

The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 1, 34-38 (2008)
DOI: 10.1177/14746514080080010801


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mcgowan, N. Articles by Mcknight, J. A Search for Related Content Social Bookmarking                         What's this?