Cholesterol under-treated in high-risk women in managed care study

01/26/05

American Heart Association journal report

DALLAS, Feb. 1 Nearly two-thirds of women at highest risk for a heart attack and death from heart disease who have dangerously high cholesterol levels are not benefiting from life-saving cholesterol-lowering medications, according to a report in today's Circulation: Journal of the American Heart Association.

"Cholesterol management in high-risk women has been proven to save lives and reduce risk of heart attacks. We wanted to determine what opportunities exist to apply the 2004 American Heart Association guidelines for cardiovascular disease prevention in women, especially in a managed care environment," says lead author Lori Mosca, M.D., Ph.D., director of preventive cardiology, NewYork-Presbyterian Hospital and associate professor of medicine at Columbia University in New York City.

Mosca and colleagues studied a 1.1 million-member managed care database and identified 8,353 women who had established cardiovascular disease at the start of the study or were otherwise at high risk because of diabetes or multiple cardiac risk factors and had not recently been on cholesterol-lowering therapy.

Laboratory and pharmacy information for these women was followed for three years to determine how doctors managed their cholesterol levels. The researchers determined how many women achieved optimal cholesterol levels based on the 2004 American Heart Association prevention guidelines for women.

The guidelines recommend LDL or "bad" cholesterol be less than 100 milligrams per deciliter (mg/dL), HDL or "good" cholesterol be more than 50 mg/dL, triglycerides be less than 150 mg/dL, or non-HDL (a combination of all bad forms of cholesterol) be less than 130 mg/dL.

"We found only 7 percent of these high-risk women had optimal levels of all cholesterol measurements at the start of the study. This improved to 12 percent after three years, still far short of where we would like to see these high-risk women," Mosca said. "We also found that only about one-third of women were receiving cholesterol-lowering medications, such as statin therapy, as recommended by national guidelines."

Very few women in the report received prescription niacin to control HDL levels, or fibrate therapy to control triglycerides, even though only about half of the women had optimal levels of HDL and triglycerides. Managing low HDL and high triglycerides with drug therapy in high-risk women was strongly recommended in the new guidelines. Evidence of poor management of these factors provides further evidence for a need to improve comprehensive lipid management in the highest-risk women, Mosca said.

"These findings suggest that therapies should be targeted to the specific cholesterol abnormalities in each woman, so that optimal levels of both the good and the bad cholesterol can be attained," Mosca said. "The reason for under-treating high cholesterol in women remains uncertain; however, the need to better apply the new guidelines and educate physicians and consumers is clear.

"Because heart disease is at least six times more likely to kill high-risk women compared to women without cardiovascular disease, reducing high-risk women's cholesterol to optimal levels is vital to winning the war against heart disease in women," Mosca said.

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