Evaluation of dyslipidemia in the emergency department: Impact of cholesterol testing on subsequent therapy

Background: Dyslipidemia is not routinely evaluated in emergency department (ED) patients. We hypothesized that many ED patients would qualify for lipid therapy and that methods of follow-up for patients would not achieve adequate treatment goals. Methods: We performed an observational study of ED patients with symptoms consistent with acute coronary syndrome (ACS). Lipid profiles and data about coronary heart disease risk factors were obtained. The National Institutes of Health/National Cholesterol Education Program guidelines were used to determine whether patients qualified for drug therapy. Six-week and 6-month follow-ups were performed. Results: Three hundred ninety-four patients presenting to the ED with possible ACS were enrolled in the study; 47 patients were subsequently excluded. The remaining 347 included patients who were 63.7% African American and 53.6% female. Proportions of patients with low-density lipoprotein ≥130 and ≥160 were 30.8% and 10.1%, respectively. Fifty-seven (16.4%, 95% CI 12.9%-20.7%) qualified for immediate drug therapy. Of the 44 patients meeting treatment criteria for whom follow-up was obtained, only 1 (2.3%) had received lipid-lowering medications with outpatient referral within 6 weeks. At 6 months, 4 (9.5%) of 42 patients with follow-up had received lipid-lowering therapies. Conclusions: Dyslipidemia meeting criteria for therapy is present in a significant proportion of ED patients. Most of these patients do not get appropriately treated on medical follow-up. Our study suggests that lipid screening and subsequent appropriate lipid-lowering therapy could be considered for ED patients with possible ACS.