Disparities in lipid management for African Americans and Caucasians with coronary artery disease: a national cross-sectional study.
BACKGROUND
Individuals with coronary artery disease are at high risk for adverse health outcomes. This risk can be diminished by aggressive lipid management, but adherence to lipid management guidelines is far from ideal and substantial racial disparities in care have been reported. Lipid treatment and goal attainment information is not readily available for large patient populations seen in the fee-for-service setting. As a result, national programs to improve lipid management in this setting may focus on lipid testing as an indicator of lipid management. We describe the detection, treatment, and control of dyslipdemia for African Americans and Caucasians with coronary artery disease to evaluate whether public health programs focusing on lipid testing can eliminate racial disparities in lipid management.


METHODS
Physicians and medical practices with high numbers of prescriptions for coronary artery disease medications were invited to participate in the Quality Assurance Program. Medical records were reviewed from a random sample of patients with coronary artery disease seen from 1995 through 1998. Data related to the detection, treatment, and control of dyslipidemia were abstracted from the medical record and evaluated in cross-sectional stratified and logistic regression analyses using generalized estimation equations.


RESULTS
Data from the medical records of 1,046 African Americans and 22,077 Caucasians seen in outpatient medical practices in 23 states were analyzed. African-American patients were younger, more likely to be women and to have diabetes, heart failure, and hypertension. The low density lipoprotein cholesterol (LDL-C) testing rate for Caucasian men was over 1.4 times higher than that for African-American women and about 1.3 times higher than that for African-American men. Almost 60% of tested Caucasian men and less than half of tested African Americans were prescribed lipid-lowering drugs. Tested and treated Caucasian men had the highest LDL-C goal attainment (35%) and African-American men the lowest (21%).


CONCLUSIONS
Although increased lipid testing is clearly needed for African Americans, improvements in treatment and control are also necessary to eliminate racial disparities in lipid management. Disparities in treatment and goal attainment must be better understood and reflected in policy to improve the health of underserved populations.
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. mmassing@mrnc.org
Mark W
MW
Massing
Kathleen A
KA
Foley
Lori
L
Carter-Edwards
Carla A
CA
Sueta
Charles M
CM
Alexander
Ross J
RJ
Simpson
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications* / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D044465:White People
D000960:Hypolipidemic Agents