Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting

• Published in: Circulation (New York, N.Y.) Vol. 111; no. 4; pp. 488 - 493
• Main Authors: MOSCA, Lori, MERZ, Noel Bairey, BLUMENTHAL, Roger S, CZIRAKY, Mark J, FABUNMI, Rosalind P, SARAWATE, Chaitanya, WATSON, Karol E, WILLEY, Vincent J, STANEK, Eric J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2005
• Subjects: Adult; Aged; American Heart Association; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Cohort Studies; Combined Modality Therapy; Coronary heart disease; Databases, Factual; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Evidence-Based Medicine; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; General aspects; Goals; Heart; Humans; Hyperlipidemias - blood; Hyperlipidemias - drug therapy; Hyperlipidemias - epidemiology; Hypolipidemic Agents - therapeutic use; Lipids - blood; Managed Care Programs; Medical sciences; Metabolic Syndrome - blood; Metabolic Syndrome - drug therapy; Metabolic Syndrome - epidemiology; Middle Aged; Patient Compliance; Practice Guidelines as Topic; Prospective Studies; Risk; Treatment Outcome; Triglycerides - blood; Vertebrates: cardiovascular system; Human; American; Managed care; Risk factor; Lipids; Cardiovascular disease; Lipoprotein; cardiovascular diseases; Cholesterol; lipoproteins; women
• DOI: 10.1161/01.CIR.0000153859.66086.85
• ISSN: 0009-7322

The American Heart Association (AHA) recently established evidence-based recommendations for cardiovascular disease (CVD) prevention in women, including lipid management. This study evaluated optimal lipid-level attainment and treatment patterns on the basis of these guidelines in high-risk women in a managed care setting. We conducted a historical prospective cohort analysis of a 1.1-million-member, integrated, managed-care database. Eligible high-risk women were those with evidence of previous CVD or risk equivalent who had a full lipid panel available between October 1, 1999, and September 30, 2000; were naive to lipid therapy; and had a minimum of 12 months health plan eligibility preindex and postindex lipid panel. Optimal lipid levels were defined as LDL cholesterol (LDL-C) <100 mg/dL, HDL cholesterol (HDL-C) >50 mg/dL, non-HDL-C <130 mg/dL, and triglycerides <150 mg/dL. Laboratory values and lipid pharmacotherapy were assessed longitudinally over the postindex follow-up (up to 36 months). A total of 8353 high-risk women (mean age, 66+/-14 years) with a mean follow-up of 27+/-8 months were included. Only 7% attained optimal combined lipid levels initially, and this increased to 12% after 36 months. Lipid-modifying therapy was initiated in 32% of patients, including 35% of women with LDL-C > or =100 mg/dL and 15% with LDL-C <100 mg/dL. Among high-risk women, few attained the AHA's standards for all lipid fractions, and only one third received recommended drug therapy, highlighting significant opportunities to apply evidence-based recommendations to manage lipid abnormalities in high-risk women.