The purpose of this study is to evaluate the effectiveness of a nurse- managed, case-management system of individualized lifestyle modification and pharmacologic intervention to manage lipid disorders in adults who have undergone coronary artery bypass graft surgery (CABG). Clinical trials have provided strong scientific evidence that lowering serum cholesterol will reduce morbidity and mortality from coronary heart disease (CHD) in patients with established CHD. Despite the clear benefits of cholesterol-lowering treatment, many patients with clinical evidence of atherosclerosis are not being treated effectively. Changes in the delivery of health care, including care for and after coronary events, mandate that we consider more effective and economical strategies for the management of lipid disorders in those with CHD so that the benefits of lipid lowering can be achieved outside of clinical drug trials. The primary aims of this study are to: 1. compare the effectiveness of a nurse-managed program for lipid modification with that of usual medical care in dyslipidemic adults who have undergone CABG in achieving the goal of a LDL-cholesterol < I 00 mg/dL or a > 20% reduction in LDL-cholesterol; 2. determine the physiologic, behavioral, and demographic predictors of goal attainment; 3. determine the cost effectiveness of a nurse-managed lipid-lowering program; and 4. assess the impact of lipid-lowering therapy on patients' quality of life. Our goal is to optimize lifestyle modification, thereby minimizing and improving the efficacy of pharmacologic intervention. We hypothesize that a significantly higher proportion of those who participate in the nurse-managed program for lipid modification will attain the goal for lipid lowering compared to those who receive usual care from their primary providers. Additionally, we propose that the intervention is a cost-effective model of delivering lipid-lowering therapy that lends itself to widespread application.
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