title: Attainment of combined optimal lipid values and the impact of lipid medication on cardiovascular outcomes and costs in a commercially insured population in the US.
abstract: OBJECTIVE
  To determine factors associated with the achievement of optimal lipid values (OLVs) and subsequent impact on clinical and economic outcomes.
  
  
  METHODS
  An observational managed care database analysis was conducted among treatment-naïve adults with elevated cardiovascular (CV) risk, >or=12 months follow-up and full lipid panel from the 1st January 2002 to the 28th February 2005. Achievement of guideline-based levels for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides was evaluated via laboratory data. Annual CV-attributable resource utilisation was assessed via medical and pharmacy claims data. Clinical and economic outcomes associated with the achievement of OLVs were assessed using multivariate regression.
  
  
  RESULTS
  A total of 52,778 patients were followed for a mean (standard deviation) of 27 (10) months with 13% achieving combined OLVs at baseline and 23% after 4 years. Of patients, 69% did not initiate lipid-modifying medication. The achievement of combined OLVs reduced the risk of CV event (odds ratio=0.86; 95% confidence interval 0.78-0.95), resource utilisation (inpatient visits: 3.36 vs. 4.41 per 100 patient years, p<0.0001; emergency department visits: 1.1 vs. 2.4 per 100 patient years, p<0.05) and costs: $703 vs. $903 per patient year, p<0.0001.
  
  
  CONCLUSIONS
  Simultaneous achievement of OLVs was rare in this patient population. Physicians should be encouraged to manage multiple risk factors aggressively to improve clinical and economic outcomes associated with CV disease.
authors.affiliation: HealthCore, Inc, Wilmington, DE 19801, USA. rquimbo@healthcore.com
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Quimbo
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Simko
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cziraky
authors.forename: Russel T
authors.initials: RT
authors.lastname: Burge
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008055:Lipids / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids