Racial differences in compliance with NCEP-II recommendations for secondary prevention at a Veterans Affairs medical center.
OBJECTIVE
The current NCEP-II guidelines recommend that secondary prevention patients should lower their LDL-cholesterol (LDL-C) below 100 mg/dL. We implemented a Lipid Management Program to aggressively achieve this goal. We report on the impact of this intervention on compliance rates for African Americans (AA) vs Whites (W) treated with an HMG-Co-A reductase inhibitor for secondary prevention at the veterans affairs hospital.


METHODS
We reviewed all patients with coronary artery disease (CAD) and/or diabetes mellitus (DM) at our institution on monotherapy with an HMG-Co-A reductase inhibitor in 1999. We examined the initial and post intervention lipid profiles for both races.


RESULTS
The groups differed in that compared to the Whites, the AA were younger (65.8 vs 71.4, P = .0001); had a higher prevalence of type 2 DM (70.1% vs 40.8%, P = .001), had more obesity (57.5% vs 41.0%, P = .001), and were more likely to smoke (42.5% vs 9.6%, P = .001). AA had more clinic visits (5.04/pt vs 3.95/pt, P = .0001) and fasting lipid profiles (4.46/pt vs 3.0/pt, P = .0001). There was no difference in the prevalence of hypertension or HMG-CoA reductase inhibitor dose. AA were less likely to achieve the goal for LDL-C recommended by NCEP-II (40.94% vs 56.9%, P = .001).


CONCLUSIONS
Despite equivalent doses of statin, AA were less likely to meet NCEP-II recommendations. This occurred even though AA had more clinic visits and lipid profiles. Our intervention did not narrow this racial gap in compliance rates. Possible explanations include: 1) variations in patient compliance; 2) impact of differences in lifestyle (DM, obesity, and smoking); and 3) the need for more intensive drug therapy in patients starting with a higher baseline LDL-C.
Williams
Marcus L
ML
Veterans Affairs of New Jersey Healthcare System, East Orange 07018-1095, USA. mlwson99@aol.com
Morris
Michael T
MT
Ahmad
Umad
U
Yousseff
Manal
M
Li
Win
W
Ertel
Norman
N
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005069:Evaluation Studies as Topic; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology*; D017410:Practice Guidelines as Topic; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin