Tailored Communication to Reduce Cardiovascular Risk

• Frequency of Clinical Encounters [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  This will measure the difference in frequency of clinical encounters in the electronic medical record.
• Medication prescriptions for Dyslipidemia [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  This will look at whether medications were prescribed for dyslipidemia.
• Medications prescribed for hypertension [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  This will measure the presence and dose of prescribed medications for hypertension.
• Presence of an aspirin prescription [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  This will measure the presence of an aspirin prescriptions on the medication list in the electronic medical record.

The primary goal of the trial is to test the feasibility and efficacy of a cardiovascular disease quality improvement system that couples EMR-based patient identification with individually tailored patient messages. The study will test the hypothesis that that a tailored patient-directed approach to cardiovascular risk reduction integrated into patients' primary care delivery site will improve control of elevated low-density lipoprotein cholesterol and other card iac risk factors more than routine care alone for patients at intermediate or high risk for cardiovascular disease.

• Hypercholesterolemia
• Coronary Artery Disease
• Dyslipidemia
• Hypertension

• Experimental: Direct-to-patient tailored cardiovascular risk message system
  Eligible patients cared for by physicians randomized to the active intervention group will be mailed a tailored cardiovascular risk message.
  Intervention: Behavioral: Direct-to-patient tailored cardiovascular risk message system
• No Intervention: Control

Inclusion Criteria:

• Age 40 to 79 years
• medication list does not include an active lipid lowering medication
• the patient does not have a diagnosis in the past medical history, active problem list or past visit encounter of coronary heart disease, heart failure, stroke, diabetes mellitus, or peripheral arterial disease
• the patient has an enrolled study physician recorded as his/her primary care physician
• the patient has an LDL cholesterol that meets one or more of the criteria listed below.

LDL cholesterol >= 130 mg/dl and estimated Framingham Risk Score 10-20% LDL cholesterol >= 100 mg/dl and estimated Framingham Risk Score >20% LDL cholesterol >= 160 mg/dl and estimated Framingham Risk Score 5% to <10%.

Exclusion Criteria:

• Age <40 or >79 years
• medication list includes an active lipid lowering medication
• the patient hase a diagnosis in the past medical history, active problem list or past visit encounter of coronary heart disease, heart failure, stroke, diabetes mellitus, or peripheral arterial disease
• the patient does not have an enrolled study physician recorded as his/her primary care physician
• the patient does not have an LDL cholesterol that meets one or more of the criteria listed below.

LDL cholesterol >= 130 mg/dl and estimated Framingham Risk Score 10-20% LDL cholesterol >= 100 mg/dl and estimated Framingham Risk Score >20% LDL cholesterol >= 160 mg/dl and estimated Framingham Risk Score 5% to <10%.