Active Lipid Management In Coronary Artery Disease (ALMICAD) Study

Purpose: Many providers have implemented specialized lipid clinics to more effectively identify, monitor, and treat hyperlipidemia in patients with coronary artery disease. The effectiveness of such a strategy is not known. We sought to investigate whether a specialized clinic achieves better lipid results and clinical outcomes than standard care. Subjects and Methods: A total of 1233 patients who had coronary disease documented by coronary angiography were randomized to lipid clinic or standard care groups by their providers and followed for 2 years. The primary end point was a composite of death, myocardial infarction, repeat revascularization, and stroke. Results: Lipid clinic (n = 617) and standard care (n = 616) groups had no significant baseline differences. After 2 years, the lipid clinic group had similar total cholesterol (166 ± 42 mg/dL vs 166 ± 41 mg/dL, P = .83), low-density lipoprotein cholesterol levels (84 ± 32 vs 85 ± 32, P = .28), and percentage of patients with low-density lipoprotein cholesterol less than 100 mg/dL (77.5% vs 77.6%, P = .97). There were no significant differences in the primary end point (12.3% vs 11.4%, P = .60) and mortality (7.6% vs 7.3%, P = .80) between the lipid clinic and standard care groups. Conclusions: In patients identified by diagnostic coronary angiography and managed within a single health care system, implementation of a specialized lipid clinic did not achieve greater attainment of hyperlipidemia treatment goals or improved cardiac outcomes.