title: The impact of concordant and discordant conditions on the quality of care for hyperlipidemia.
abstract: BACKGROUND
  Physician treatment of cardiovascular risk factors may be affected by specific types of patient comorbidities.
  
  
  OBJECTIVE
  To examine the relationship between discordant comorbidities and LDL-cholesterol management in hypertensive patients not previously treated with lipid-lowering therapy; to determine whether the presence of cardiovascular (concordant) conditions mediates this relationship.
  
  
  METHODS
  We performed a retrospective cohort study of 1,935 hypertensive primary care patients (men >45 years of age, women >55 years of age) with documented elevated low-density lipoprotein (LDL) cholesterol and no lipid-lowering therapy at baseline. The outcome was guideline-consistent hyperlipidemia management defined as optimal value on repeat LDL cholesterol testing or initiation of lipid-lowering therapy. Using generalized estimating equations (GEE), we examined the association of concordant and discordant comorbidities with guideline-consistent hyperlipidemia management over a 2-year follow-up period, adjusting for patient characteristics.
  
  
  RESULTS
  Guideline-consistent hyperlipidemia management was achieved in 1,236 patients (64%). In the fully adjusted model, each additional discordant condition resulted in a 19% lower adjusted odds ratio of guideline-consistent hyperlipidemia management (p < 0.001) when compared with no discordant conditions. The dampening effect of discordant conditions on guideline-consistent management persisted even in the presence of concordant conditions, but each additional concordant condition was associated with a 37% increase in the adjusted odds of guideline-consistent hyperlipidemia management (p < 0.001).
  
  
  CONCLUSIONS
  In this cohort of hypertensive primary care patients, the number of conditions discordant with cardiovascular risk was strongly negatively associated with guideline-consistent hyperlipidemia management even in patients at the highest risk for cardiovascular events and cardiac death.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA. lagutc@gmail.com
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Susan
authors.initials: S
authors.lastname: Eachus
authors.forename: Craig S
authors.initials: CS
authors.lastname: Roberts
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL