Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting.
BACKGROUND
The American Heart Association (AHA) recently established evidence-based recommendations for cardiovascular disease (CVD) prevention in women, including lipid management. This study evaluated optimal lipid-level attainment and treatment patterns on the basis of these guidelines in high-risk women in a managed care setting.


RESULTS
We conducted a historical prospective cohort analysis of a 1.1-million-member, integrated, managed-care database. Eligible high-risk women were those with evidence of previous CVD or risk equivalent who had a full lipid panel available between October 1, 1999, and September 30, 2000; were naive to lipid therapy; and had a minimum of 12 months health plan eligibility preindex and postindex lipid panel. Optimal lipid levels were defined as LDL cholesterol (LDL-C) <100 mg/dL, HDL cholesterol (HDL-C) >50 mg/dL, non-HDL-C <130 mg/dL, and triglycerides <150 mg/dL. Laboratory values and lipid pharmacotherapy were assessed longitudinally over the postindex follow-up (up to 36 months). A total of 8353 high-risk women (mean age, 66+/-14 years) with a mean follow-up of 27+/-8 months were included. Only 7% attained optimal combined lipid levels initially, and this increased to 12% after 36 months. Lipid-modifying therapy was initiated in 32% of patients, including 35% of women with LDL-C > or =100 mg/dL and 15% with LDL-C <100 mg/dL.


CONCLUSIONS
Among high-risk women, few attained the AHA's standards for all lipid fractions, and only one third received recommended drug therapy, highlighting significant opportunities to apply evidence-based recommendations to manage lipid abnormalities in high-risk women.
Mosca
Lori
L
Columbia University, New York, NY, USA. ljm10@columbia.edu
Merz
Noel Bairey
NB
Blumenthal
Roger S
RS
Cziraky
Mark J
MJ
Fabunmi
Rosalind P
RP
Sarawate
Chaitanya
C
Watson
Karol E
KE
Willey
Vincent J
VJ
Stanek
Eric J
EJ
D000328:Adult; D000368:Aged; D000572:American Heart Association; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D008329:Managed Care Programs; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D008055:Lipids; D014280:Triglycerides