title: A retrospective cohort study of the potency of lipid-lowering therapy and race-gender differences in LDL cholesterol control.
abstract: BACKGROUND
  Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.
  
  
  METHODS
  We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.
  
  
  RESULTS
  Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.
  
  
  CONCLUSIONS
  Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.
authors.affiliation: Division of General Internal Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA. turner@uthscsa.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Mark
authors.initials: M
authors.lastname: Weiner
authors.forename: Simon S K
authors.initials: SS
authors.lastname: Tang
mesh_terms: D001741:Black or African American; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D015331:Cohort Studies; D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D044465:White People
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL