Subject(s)
Cardiovascular Diseases/ethnology , Ethnicity/statistics & numerical data , Minority Groups/statistics & numerical data , Adult , Black or African American/genetics , Black or African American/statistics & numerical data , Aged , Arteriosclerosis/ethnology , Asian/statistics & numerical data , Cardiovascular Diseases/prevention & control , Cause of Death , Clinical Trials as Topic/statistics & numerical data , Communication Barriers , Delivery of Health Care , Disease Susceptibility , Ethnicity/genetics , Female , Genetic Predisposition to Disease , Health Services Accessibility , Hispanic or Latino/statistics & numerical data , Humans , Indians, North American/statistics & numerical data , Japan/ethnology , Male , Middle Aged , Prejudice , Professional-Patient Relations , Risk Factors , Social Justice , United States/epidemiologyABSTRACT
BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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.
Subject(s)
Hyperlipidemias/drug therapy , Lipids/blood , Managed Care Programs , Adult , Aged , American Heart Association , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cohort Studies , Combined Modality Therapy , Databases, Factual , Evidence-Based Medicine , Female , Follow-Up Studies , Goals , Humans , Hyperlipidemias/blood , Hyperlipidemias/epidemiology , Hypolipidemic Agents/therapeutic use , Metabolic Syndrome/blood , Metabolic Syndrome/drug therapy , Metabolic Syndrome/epidemiology , Middle Aged , Patient Compliance , Practice Guidelines as Topic , Prospective Studies , Risk , Treatment Outcome , Triglycerides/bloodABSTRACT
BACKGROUND: Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender. METHODS AND RESULTS: An online study of 500 randomly selected physicians (300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles (P<0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin (P<0.01) and more weight management recommended (P<0.04) for intermediate-risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD. CONCLUSIONS: Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.