Table 4.
Hyperlipidemia
| Reference | Design | Intervention | n, Follow-Up, Racial/Ethnic Composition | Setting | Results: Process and Patient Outcomes | Conclusion | Target | Quality Score |
|---|---|---|---|---|---|---|---|---|
| Ard 2000 | Randomized modified crossover | Diet and exercise program included 1,000 kcal diet, culturally sensitive recipes, and address of exercise attitudes | n = 56, 8 weeks, 100% AA | Academic health center | Average weight loss 14.8 lb; BMI: 37.8 to 35.3 (p < .01); total cholesterol: 199 to 185 (p < .01); SBP and DBP decreased by 4.3 (p < .01) and 2.4 (p < .05); control group: no significant change | A culturally sensitive diet and exercise intervention can reduce BMI, cholesterol, and BP | Patient/family | 12 |
| Becker 2005 | RCT | Community-based multiple risk factor intervention on CV risk in black families with a history of premature coronary disease; CBC group received NP-led, community-based multi-component education and management intervention compared to EPC | n = 364, 1 year, 100% AA | Primary care and nonclinical community sites | CBC group was two times more likely to achieve goal levels of LDL cholesterol and BP compared with the usual-care group (95% CI: 1.11 to 4.20 and 1.39 to 3.88, respectively) | Multifaceted NP-directed community-based intervention can improve HTN, lipids, and tobacco cessation rates in a high-risk population | Provider & care delivery | 18 |
| Burden 2002 | Pre/post study | Pharmacist-led lipid reduction with initial 1-hr visit and follow-up every 6 weeks until stable, then every 6-12 months; dietician visit; exercise encouraged | n = 74, 8 months, 100% Native Americans | Clinic at an Indian Health Services Hospital | 2.1 mg/dL increase in HDL (p = .01) | Pharmacist-directed lipid management resulted in modest improvement in HDL | Patient/family | 12 |
| Haskell 2006 | RCT | Multifaceted disease management intervention using team case management | n = 148, 1 year, 89% minority (57% Hispanic, 11% Asian, 7% AA) | Urban community clinics serving low-income patients | Disease management produced clinically important decreases in selected risk factors compared with usual care, including SBP (p < .01) and LDL cholesterol (p < .03) | Disease management targeted at high-risk patients (24% had CAD, 64% had no health insurance) can improve HTN and lipids | Provider & care delivery | 21 |
| Jenkins 2006 | Pre/post study | General CV disease quality improvement | n = 2,860, 1 year, 48% AA with subgroup analysis | Academic family practice clinic | Significant improvements occurred in BP control for all adults (OR = 1.44) and those with HTN (OR = 1.82); measures of total cholesterol (OR = 1.10) and HDL cholesterol (OR = 1.27) for all patients | Multifaceted intervention can improve process measures and CV outcomes | Provider & care delivery | 17 |
| Keyserling 1997 | RCT | 90-min tutorial, brief dietary assessment, and three 5-10-min diet counseling sessions by the primary care clinician; dietitian referral if LDL remained high at 4-month follow-up; clinician prompt to consider meds based on LDL at 7-months | n = 372, 7 months, 40% AA, 11% Native American | 21 rural and community health centers | 5.3 mg/dL greater reduction in total cholesterol for intervention group averaged over 1 year; increased rate of lipid medication use | Dietary intervention had minimal effect on lipid control in this low-income group | Provider & care delivery | 19 |
| Kokkinos 1998 | RCT | Moderate-intensity aerobic exercise for 20-50 min, 3 times/week for 16 weeks | n = 36, 16 weeks, 100% AA | Not mentioned | No change in lipids except HDL at 75% intensity (p = .003) | Low- to moderate-intensity aerobic exercise may not be enough to modify lipid profiles in patients with severe HTN, but increases in HDL suggest exercise intensity threshold | Provider & care delivery | 17 |
| Kumanyika 1999 | RCT | CV nutrition program using food cards, audiotapes, and four classes vs. cards and nutrition guide | n = 255, 1 year, 100% AA | Community-based clinic affiliated with an academic medical center | Trend toward improvement but no significant difference in lipids and BP | Intensive nutrition intervention may improve lipid and BP control | Provider & care delivery | 19 |
| Poston 2001 | RCT with block design | Culturally appropriate intervention: weekly 90-min meetings using individual-oriented, culturally tailored behavioral techniques and reading materials; wait-list control group did not receive intervention but were assessed at baseline and 6 and 12 months | n = 379, 12 months, 100% Mexican American women | Home and community centers | No difference in physical activity or cholesterol levels among the study participants; higher drop out rate in treatment group p < .001. | Culturally appropriate intevention consisting of weekly meetings, written materials, and behavioral techniques was not effective in increasing exercise or improving lipids in this challenging population | Patient/family | 19 |
Note: AA = African American; BMI = body mass index; BP = blood pressure; CAD = coronary artery disease; CBC = community-based care; CV = cardiovascular; DBP = diastolic blood pressure; EPC = enhanced primary care; HTN = hypertension; NP = nurse practitioner; SBP = systolic blood pressure.