Ambulatory hypercholesterolemia management in patients with atherosclerosis. Gender and race differences in processes and outcomes.
OBJECTIVE
To determine whether outpatient cholesterol management varies by gender or race among patients with atherosclerosis, and assess factors related to subsequent cholesterol control.


METHODS
Retrospective cohort study.


METHODS
Primary care clinics affiliated with an academic medical center.


METHODS
Two hundred forty-three patients with coronary heart disease, cerebrovascular disease, or peripheral vascular disease and low-density lipoprotein cholesterol (LDL-C)>130 mg/dl.


RESULTS
The primary process of care assessed for 1,082 office visits was cholesterol management (medication intensification or LDL-C monitoring). Cholesterol management occurred at 31.2% of women's and 38.5% of men's visits (P=.01), and 37.3% of black and 31.7% of white patients' visits (P=.09). Independent predictors of cholesterol management included female gender (adjusted risk ratio [ARR], 0.77; 95% confidence interval [CI], 0.60 to 0.97), seeing a primary care clinician other than the patient's primary care physician (ARR, 0.23; 95% CI, 0.11 to 0.45), and having a new clinical problem addressed (ARR, 0.60; 95% CI, 0.48 to 0.74). After 1 year, LDL-C <130 mg/dl occurred less often for women than men (41% vs 61%; P=.003), black than white patients (39% vs 58%; P=.01), and patients with only Medicare insurance than with commercial insurance (37% vs 58%; P=.008). Adjustment for clinical characteristics and management attenuated the relationship between achieving an LDL-C <130 mg/dl and gender.


CONCLUSIONS
In this high-risk population with uncontrolled cholesterol, cholesterol management was less intensive for women than men but similar for black and white patients. Less intense cholesterol management accounted for some of the disparity in cholesterol control between women and men but not between black and white patients.
Persell
Stephen D
SD
Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2927, USA. spersell@nmff.org
Maviglia
Saverio M
SM
Bates
David W
DW
Ayanian
John Z
JZ
D000046:Academic Medical Centers; D001741:Black or African American; D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000032:analysis; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011320:Primary Health Care / Q000592:standards*; D012737:Sex Factors; D044465:White People
D008078:Cholesterol, LDL