ACCEPT Clinical System 2010

 

Healthcare reform and heart disease and stroke prevention are driven by data. Clinical outcomes and reduced consumption of expensive healthcare resources depend on successfully reaching treatment goals.

Drs. Rolando and Emil deGoma presented their performance data using ACCEPT system for cholesterol and cardiovascular risk management in the annual national meeting of the Society of General Internal Medicine in 2006.

Overall, 85% of high risk patients (89% of men and 78% of women) were treated of an LDL goal less than 100. This is superior to 4 other published data.

Detailed comparison of the LDL cholesterol level distribution between L-TAP study and Dr. deGoma's practice.

The difference is marked. In L-TAP only 18% (green) were treated successfully, compared to 85% using ACCEPT. ACCEPT is an acronym for A Cholesterol Clinic in Every Practice. With over 40 million high risk Americans eligible for treatment, the only way to treat such a large number to target goals is to empower all adult medical practices to become basic cholesterol clinics by educating physicians and providing them with a practical, MD-friendly, cost-effective management system.

Optimal Lipid Therapy is the Cornerstone of Cardiovascular Disease Prevention

While physicians need to address all modifiable risk factors and use evidence-based therapies to treat high risk patients to recommended goals, optimal lipid therapy is the cornerstone of heart attack and stroke prevention. No other treatment can match the large volume of scientific data from placebo-controlled lipid clinical trials. Analysis of the STENO-2 showed that lipid therapy accounted for more than 70% of the cardiovascular risk reduction.

Whereas many clinical trials confirmed that lower LDL cholesterol is better, not so with diabetes and blood pressure. Recent ACCORD trial showed that intensive diabetic (HbA1c <6) and blood pressure (systolic pressure <120) treatment goals were associated with worse, not better, patient outcomes. For LDL cholesterol, less than 100 is optimal but less than 70 is even better for high risk patients.

The Number Needed to Treat for 5 years (NNT₅) to prevent one serious event gives an indication of both potency and cost effectiveness of different preventive therapies. No other treatment comes close to statin therapy.

For secondary prevention, the NNT₅ is as low as 10 patients with CHD and diabetes in the 4S trial.

For primary prevention, NNT₅ is 48 in the WOSCOP study, 20 in the JUPITER trial.

For moderate hypertension, NNT₅ is 128.

For annual mammography, NNT₁₄ to prevent one death from breast cancer (14 years, not 5 years) varies from 1,592 to 1,792.

 

Some may disagree about the exact NNT₅ numbers (12 or 15, not 10) but no one will contest the potency, safety and cost effectiveness of statin therapy in patients at risk. Simvastatin is now generic; atorvastatin will be soon. A thirty day supply of simvastatin 40 mg costs $3.50 - that's 11 cents a pill, instead of $2.50 to $3.50 per pill before the generic version became available.