Effects of an evidence-based computerized virtual clinician on low-density lipoprotein and non-high-density lipoprotein cholesterol in adults without cardiovascular disease: The Interactive Cholesterol Advisory Tool

There is a lack of research on the use of electronic tools that guide patients toward reducing their cardiovascular disease risk. We conducted a 9-month clinical trial in which participants who were at low (n = 100) and moderate (n = 23) cardiovascular disease risk—based on the National Cholesterol Education Program III’s 10-year risk estimator—were randomized to usual care or to usual care plus use of an Interactive Cholesterol Advisory Tool during the first 8 weeks of the study. In the moderate-risk category, an interaction between treatment condition and Framingham risk estimate on low-density lipoprotein and non-high-density lipoprotein cholesterol was observed, such that participants in the virtual clinician treatment condition had a larger reduction in low-density lipoprotein and non-high-density lipoprotein cholesterol as their Framingham risk estimate increased. Perceptions of the Interactive Cholesterol Advisory Tool were positive. Evidence-based information about cardiovascular disease risk and its management was accessible to participants without major technical challenges.

[1]  R. Collins,et al.  The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials , 2012, The Lancet.

[2]  C. Scott Rigby,et al.  Virtual Look AHEAD Program: Initial Support for a Partly Virtualized Intensive Lifestyle Intervention in Type 2 Diabetes , 2014, Diabetes Care.

[3]  James J. Cimino,et al.  Research Paper: A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study , 2009, J. Am. Medical Informatics Assoc..

[4]  Neil J Stone,et al.  Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines , 2004, Circulation.

[5]  Jianwen Cai,et al.  A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies , 2011, BMC health services research.

[6]  Matthew K Ito,et al.  Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education. , 2013, Journal of clinical lipidology.

[7]  Hanyu Ni,et al.  Trends from 1987 to 2004 in sudden death due to coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. , 2009, American heart journal.

[8]  J. Mckenney,et al.  National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) , 2002 .

[9]  Susan M McCurry,et al.  The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. , 2007, Diabetes technology & therapeutics.

[10]  Kari Harno,et al.  Managing diabetes care using an integrated regional e-health approach , 2006, Journal of telemedicine and telecare.

[11]  Niteesh K Choudhry Copayment levels and medication adherence: less is more. , 2009, Circulation.

[12]  Jennifer G. Robinson,et al.  2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[13]  Paul A Estabrooks,et al.  Twelve-month outcomes of an Internet-based diabetes self-management support program. , 2012, Patient education and counseling.

[14]  Blackford Middleton,et al.  Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. , 2008, Archives of internal medicine.

[15]  R. Collins,et al.  The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. , 2012, Lancet.

[16]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[17]  Alan S. Brown,et al.  Use of health information technology (HIT) to improve statin adherence and low-density lipoprotein cholesterol goal attainment in high-risk patients: proceedings from a workshop. , 2013, Journal of clinical lipidology.

[18]  Jun Ma,et al.  National Trends in Statin Use by Coronary Heart Disease Risk Category , 2005, PLoS medicine.

[19]  D. Karalis,et al.  Effect of health information technology interventions on lipid management in clinical practice: a systematic review of randomized controlled trials. , 2013, Journal of clinical lipidology.

[20]  David Lyle,et al.  Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial , 2013, BMC Health Services Research.

[21]  Lawrence Joseph,et al.  Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial. , 2007, Archives of internal medicine.

[22]  E. Deci,et al.  Self-Determination Theory Applied to Health Contexts , 2012, Perspectives on psychological science : a journal of the Association for Psychological Science.

[23]  J Wierdsma,et al.  Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial , 2012, BMJ : British Medical Journal.

[24]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[25]  S. Grundy,et al.  National Cholesterol Education Program Third Report of the National Cholesterol Education Program ( NCEP ) Expert Panel on Detection , Evaluation , and Treatment of High Blood Cholesterol in Adults ( Adult Treatment Panel III ) Final Report , 2022 .