• Stephen D Persell, Tiffany Brown, Ji Young Lee, Shreya Shah, Eric Henley, Timothy Long, Stephanie Luther, Donald M Lloyd-Jones, Muriel Jean-Jacques, Namratha R Kandula, Thomas Sanchez, and David W Baker.
• From the Division of General Internal Medicine and Geriatrics, Department of Medicine (S.D.P., T.B., J.Y.L., S.S., M.J.-J., N.R.K., D.W.B.), Center for Primary Care Innovation, Institute for Public Health and Medicine (S.D.P., N.R.K., D.W.B.), Division of Cardiology (D.M.L.-J.), and Department of Preventive Medicine (D.M.L.-J., N.R.K.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Medicine, Stanford University, Stanford, CA (S.S.); North Country Healthcare, Flagstaff, AZ (E.H.); Near North Health Service Corporation, Chicago, IL (T.L., T.S.); Alliance of Chicago Community Health Services, Chicago, IL (T.L., T.S.); and Heartland Health Outreach, Chicago, IL (S.L.). spersell@nm.org.
• Circ Cardiovasc Qual. 2015 Nov 1; 8 (6): 560-6.

BackgroundMany eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk.Methods And ResultsWe performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up.ConclusionsRisk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines.Clinical Trial RegistrationURL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.© 2015 American Heart Association, Inc.

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