New Approaches to

Patient Care and

Education After
COVID-19?
James A. Underberg, MD, MS,
FACPM, FACP, FASH, FNLA
Clinical Assistant Professor of Medicine NYU School of Medicine
NYU Langone Center for Cardiovascular Disease Prevention
Director, Bellevue Hospital Lipid Clinic, New York, NY
Past-President National Lipid Association
President American Board of Clinical Lipidology
Diplomate American Board of Clinical Lipidology
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 The Lipid Clinic team (led by a clinical nurse), included a clinical pharmacist, nurse
practitioner, dietitian, and clinical psychologist.
Objective: To compare the success of a limited term of treatment in the Lipid Clinic with that of standard
physician- based care in the General Internal Medicine Clinic in achieving the goals recommended by the
National Cholesterol Education Program I for low-density lipoprotein cholesterol.

Results: After four clinic visits, patients in the Lipid Clinic group were four times more likely to reach a
National Cholesterol Education Program I goal of a low-density lipoprotein cholesterol level less than 3.36
mmol/L (130 mg/dL) than were comparable patients in the General Internal Medicine Clinic group
These results support multidisciplinary, goal-oriented collaborative practice as an efficacious model
of preventive medicine and health care provision.
Arch Intern Med. 1995;155:2330-2335
At the end of 6 months, 69% of patients in the pharmacist-managed clinic achieved their
LDL goal, compared with 50% of controls.

Compliance with laboratory tests and drug regimens also improved in clinic patients.
Compliance with lipid panels went from 8% 2 months before to 89% 2 months after the
start of the study.

At the end of 6 months compliance with laboratory work and refills was 80%.
Pharmacotherapy 2000;20(11):1375–1383
OBJECTIVE: To describe the development of a pharmacist-managed lipid clinic within a primary care
medical clinic and review its results after approximately 12 months of operation.

RESULTS: Relative to baseline, LDLC decreased 20%, HDLC increased 11%, and TG’S decreased 19%.
Overall, LDLC goals were reached in 77% of the patients. LDLC goals were attained by 63%, 79%, and
93% of patients with targets of <100, <130, and <160 mg/dL, respectively. Results are compared with
other studies regarding lipid goal attainment.

CONCLUSIONS: A pharmacist-managed lipid clinic can be developed and integrated into a primary care
medical clinic. Pharmacists can effectively manage lipid-lowering therapy, helping to achieve LDL goals.

Ann Pharmacother 2002;36:892-904.

 This roundtable discussion with 4 experts examines
multiple aspects of lipid clinic operations:
obtaining referrals, adapting to either the academic
or community setting, organizing a team of
providers, incorporating diet and lifestyle
counseling as well as medication, establishing the
pharmacist role, and gaining financial stability.

Journal of Clinical Lipidology, Vol 13, No 4, August 2019

 Central Characteristics That Define a Lipid Clinic

▪ Dedicated and competent staff (ABCL/ACCL certified or

eqivalent)
▪ Patient appointment schedule dedicated exclusively to
lipid/lipoprotein disorders
▪ Defined treatment pathways for both straight-forward and
complex lipid/lipoprotein disorders
▪ Diagnosis and management of more complex
dyslipidemias, e.g., FH, apoprotein abnormalities, type I,
III, IV, and V dyslipidemia
▪ Proficiency with using advanced lipoprotein/ biomarker tests
▪ Outcomes tracking provision
▪ Dedicated lifestyle therapy
* Level I: Straight forward diagnosis and therapy; modest
attendance to complex cases
Level II: ABCL lipidologist Med. Dir., specialization in
complex dyslipidemias/dyslipoproteinemias
La Forge, 2011
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