title: Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women.
abstract: Studies show women do not receive aggressive cardiovascular interventions and may not be given guideline-based treatment to reduce cardiac events. We describe cholesterol treatment in an academic practice of family and internal medicine physicians to understand factors associated with achievement of guideline-based treatment goals in women compared with men. Primary care patients aged 40 to 75 years were included if they were prescribed a statin, had a Framingham risk score of ≥ 10%, had diabetes, or had atherosclerotic cardiovascular disease. Patients were classified into Adult Treatment Panel III categories and assessed to whether they were in compliance with Adult Treatment Panel III guidelines. Odds ratios of goal adherence between women and men were calculated, and a multivariate model for goal achievement was created. In 2,747 patients, women were less likely to achieve cholesterol goals (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70 to 0.95) despite having more prescriptions for statins (48% vs 39%, p <0.001). More women than men failed to reach low-density lipoprotein goals because they were not prescribed a statin (OR 0.69; 95% CI 0.56 to 0.85) and women on high-intensity statins were less likely than men to achieve goals (OR 0.51; 95% CI 0.27 to 0.96). In all patients, diabetes was associated with nonattainment of cholesterol goals, but in high-risk women, the presence of diabetes improved goal achievement. In conclusion, women achieved guideline-based cholesterol recommendations at a lower rate than men, even when individual goals are considered.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri. Electronic address: schoenmw@slu.edu.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Schoen
authors.affiliation: Prevention Research Center, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Tabak
authors.affiliation: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
authors.forename: Joanne
authors.initials: J
authors.lastname: Salas
authors.affiliation: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
authors.forename: Fred R
authors.initials: FR
authors.lastname: Buckhold
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D002784:Cholesterol