Opportunity for Intervention to Achieve American Heart Association Guidelines for Optimal Lipid Levels in High-Risk Women in a Managed Care Setting

Abstract

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) Ͻ100 mg/dL, HDL cholesterol (HDL-C) Ͼ50 mg/dL, non-HDL-C Ͻ130 mg/dL, and triglycerides Ͻ150 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, 66Ϯ14 years) with a mean follow-up of 27Ϯ8 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 Ն100 mg/dL and 15% with LDL-C Ͻ100 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. (Circulation. 2005;111:488-493.)

Cardiovascular risk status and primary prevention in postmenopausal women: the MENOCARD study

“…Consequently, in the Women's Health Initiative study, BP was controlled in only 36.1% of hypertensive postmenopausal women, with lower rates of control in the oldest group [12]. Furthermore, even among high-risk women, only 7-12% attain the AHA's standards for all lipid fractions, and only onethird receive recommended drug treatment, highlighting the significant opportunities to apply evidencebased recommendations to manage lipid abnormalities in high-risk women [16].…”

Sex-Specific Time Trends in Very Elderly Patients (Aged ≧80 Years) Hospitalized with Myocardial Infarction

“…At first glance, the approximately 3% rise for very elderly men and 5% rise for very elderly women over the 10-year period, although statistically significant, may not seem impressive. However, when put in the context of what appears to be diminishing absolute numbers of MI hospitalization in the overall population, established disparities in cardiovascular care unfavorable to women [4], the relentless aging of the US population [5], known poorer clinical outcomes after MI in the very elderly [2] and a recognized underutilization of proven vascular risk reduction treatments in the very-elderly age group [6], the findings could be of growing public health importance.…”

“…Similarly, the comparatively greater longevity and delayed incidence of first MI in women versus men [5] may be contributing to the steeper rise in the proportion of the former hospitalized with MI. It is also possible that the undertreatment of cardiovascular risk factors observed among relatively younger women compared to men might also play a role in this disparate increase [4]. …”

HDL-C in post-menopausal women: An important therapeutic target

“…In HERS [44] only about one-half of women who met defined criteria for lipid-lowering therapy [25] were receiving statin therapy; even at the end of the study, only about two-thirds of women who met these criteria were on statin therapy. Furthermore, in a cohort analysis of 8353 women at high risk of CHD in a managed care setting, only 12% achieved target lipid levels as defined by current treatment guidelines [25,28,29] during treatment over a 3-year follow-up period [45].…”