Background
In coronary heart disease (CHD) patients, ATP III guidelines (2001) recommended LDL-C goal of <100 mg/dl, with optional goal of <70 in a 2004 update, and in patients with triglycerides (TG) ≥ 200mg/dl, non-HDL-C goal of <130 mg/dl with optional goal of <100. In a 2003 survey (NEPTUNE II), 62% of CHD patients achieved LDL-C goal of < 100 mg/dl but only 33% achieved both LDL-C and non-HDL-C goals.
Methods
To assess whether goal attainment has improved, we analyzed data from 7 Veterans Affairs (VA) medical centers. In patients with ICD-9 codes for CHD and a primary care visit in 2008, we assessed LDL-C and (in patients with TG ≥200 mg/dl) non-HDL-C (calculated as total cholesterol - HDL-C), to compare goal attainment for LDL-C and non-HDL-C in the VA system with NEPTUNE II.
Results
We analyzed 24,769 CHD patients. Significantly more VA patients (
table
) attained LDL-C goals per ATP III guidelines. Attainment of optional LDL-C goals per the 2004 update was statistically better than NEPTUNE II, but still low (34%). A major treatment gap was noted in patients with TG ≥ 200, with poor attainment for both LDL-C (primary goal) and non-HDL-C (secondary goal) per both ATP III (51%) and the update (12%), although goal attainment was better in the VA patients compared to NEPTUNE II. Controlling for facility clustering and patient's illness severity, non-physician providers (p=0.07), care at a teaching facility (p=0.09), patient's age > 55 years (p= 0.001) and diabetes (p=0.005) were positively associated with goal attainment, whereas African American patients were less likely to achieve lipid goals (p=0.04).
Conclusion
LDL-C goal attainment per ATP III guidelines has improved, but attainment of <70 mg/dl in CHD patients remains low. CHD patients with elevated TG continue to have poor attainment of non-HDL-C goals, which recent data indicate is as important as LDL-C goal attainment. We also identify factors associated with goal attainment which have implications for future interventions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.