Increase in lipid-lowering treatment rates among TRICARE beneficiaries: a population-based study.
OBJECTIVE
To evaluate the use of lipid-lowering treatment (LLT) among patients at risk for cardiovascular disease (CVD) in the US Military Health System (MHS).


METHODS
The study examined healthcare service and prescription records among beneficiaries > or =18 years for calendar years 2002, 2004, and 2006. Patients were categorized based on cardiovascular (CV) risk, with exposure to LLT defined as one or more prescriptions for lipid-lowering medication. Logistic regression models estimated odds of treatment in 2004 and 2006 relative to 2002 after adjustment for age, gender, and CV risk.


RESULTS
The yearly unadjusted population prevalence of LLT increased from 9.3% in 2002 to 14.7% in 2006. Among subjects with the highest CV risk, established coronary artery disease (CAD) or peripheral vascular disease (PVD), those receiving LLT increased from 55% in 2002 to 65% in 2006 (adjusted OR = 1.50, 95% CI 1.48, 1.52, p < 0.00). Treatment rates among diabetic patients with no coded CAD or PVD showed the largest relative increase from 47% in 2002 to 66% in 2006 (adjusted OR = 2.30, 95% CI 2.26, 2.332, p < 0.00). LLT growth was lowest among those with only 1 coded CV risk factor (adjusted OR = 1.32, 95% CI 1.31, 1.34, p < 0.00).


CONCLUSIONS
The MHS experienced a significant increase in LLT among patients at greatest risk for cardiovascular disease. However, treatment may still be underutilized as approximately one-third of high-risk patients did not receive lipid-lowering medication.
Devine
Joshua
J
Department of Defense Pharmacoeconomic Center, Fort Sam Houston, TX 78234, USA. josh.devine@amedd.army.mil
Linton
Andrea
A
Mistry
Harsha
H
Napier
Josh
J
Trice
Shana
S
Bacon
Thomas
T
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D011307:Drug Prescriptions; D004363:Drug Utilization; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007348:Insurance, Health / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data; D016017:Odds Ratio; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult
D000960:Hypolipidemic Agents