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

Negi SI, Steinberg L, Polsani VR, Gowani SA, Nambi V, Kumar V, Marinescu V, Jones PH, Petersen LA, Ballantyne CM, Virani SS. Non-high-density lipoprotein cholesterol calculation and goal awareness among physicians-in-training. Journal of clinical lipidology. 2012 Jan 1; 6(1):50-7.

Related HSR&D Project(s)

• CDA 09-028 – Attaining Optimal Non-HDL Cholesterol Levels to Improve Cardiac Outcomes

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Abstract:

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.