ABSTRACT
OBJECTIVE: The current NCEP-II guidelines recommend that secondary prevention patients should lower their LDL-cholesterol (LDL-C) below 100 mg/dL. We implemented a Lipid Management Program to aggressively achieve this goal. We report on the impact of this intervention on compliance rates for African Americans (AA) vs Whites (W) treated with an HMG-Co-A reductase inhibitor for secondary prevention at the veterans affairs hospital. METHODS: We reviewed all patients with coronary artery disease (CAD) and/or diabetes mellitus (DM) at our institution on monotherapy with an HMG-Co-A reductase inhibitor in 1999. We examined the initial and post intervention lipid profiles for both races. RESULTS: The groups differed in that compared to the Whites, the AA were younger (65.8 vs 71.4, P = .0001); had a higher prevalence of type 2 DM (70.1% vs 40.8%, P = .001), had more obesity (57.5% vs 41.0%, P = .001), and were more likely to smoke (42.5% vs 9.6%, P = .001). AA had more clinic visits (5.04/pt vs 3.95/pt, P = .0001) and fasting lipid profiles (4.46/pt vs 3.0/pt, P = .0001). There was no difference in the prevalence of hypertension or HMG-CoA reductase inhibitor dose. AA were less likely to achieve the goal for LDL-C recommended by NCEP-II (40.94% vs 56.9%, P = .001). CONCLUSION: Despite equivalent doses of statin, AA were less likely to meet NCEP-II recommendations. This occurred even though AA had more clinic visits and lipid profiles. Our intervention did not narrow this racial gap in compliance rates. Possible explanations include: 1) variations in patient compliance; 2) impact of differences in lifestyle (DM, obesity, and smoking); and 3) the need for more intensive drug therapy in patients starting with a higher baseline LDL-C.
