"Under-treatment of cholesterol disorders is a major public health challenge," said lead author David Goff Jr., M.D., Ph.D. "In our study of middle-age and older adults with no symptoms of cardiovascular disease, about a third had cholesterol disorders that would require drug treatment under current guidelines. Yet, only 54 percent of those who needed treatment were getting it."
In addition, the researchers found that cholesterol control was lowest in study participants who were at the highest risk of developing heart vessel disease. Cholesterol disorders – such as having "good" cholesterol that is too low or "bad" cholesterol that is too high – are a major risk factor for cardiovascular disease, which is the leading cause of death in the United States.
"Cardiovascular disease is a significant health problem in this country and lipid-lowering therapy has been proven to help prevent it," said Goff, a professor of public health sciences and internal medicine at Wake Forest's School of Medicine, part of Wake Forest University Baptist Medical Center. "Our research illustrates the importance of improving the treatment and control of cholesterol disorders and eliminating treatment disparities."
The data came from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study of 6,814 men and women who had no known cardiovascular disease. Caucasian, Hispanic, Chinese and African-American participant were recruited some six communities (Forsyth County, Baltimore, Chicago, Los Angeles, northern Manhattan, N.Y., and St. Paul, Minn.).
The study's main objective is to determine the characteristics of early cardiovascular disease – before symptoms develop – and how it progresses. The goal of the current analysis was to learn more about the challenge of implementing cholesterol treatment guidelines issued by the National Cholesterol Education Program.
For the study, researchers measured participants' blood pressure, height, weight and cholesterol and asked them about family history of heart attack, current smoking, and current prescription drugs. Each participant's 10-year risk of developing disease of the coronary arteries was calculated, and they were classified as being low risk, moderate risk or high risk.
"We found that cholesterol disorders were common in this population that is free of known cardiovascular disease," said Goff. "And we found that cholesterol treatment and control is far from optimal. The high-risk group had the lowest level of control and there was evidence of gender and ethnic disparities in both treatment and control."
Among participants with cholesterol disorders, men were 20 percent less likely than women to be treated. Blacks and Hispanics were less likely (15 percent and 20 percent, respectively) than whites to be treated. The researchers believe that the gender and ethnic disparities may be related both to access to care and the tendency to seek health care.
Women are more likely than men to have health insurance and are reported to seek health care services more often than men, the researchers said. Blacks and Hispanics also have lower health insurance coverage rates and poorer access to care.
"Our study showed that more research and quality improvement programs are needed to optimize management of cholesterol disorders," Goff said.
The study was funded by the National Heart, Lung and Blood Institute. Co-researchers were Alain Bertoni, M.D., M.P.H., and Denise Bonds, M.D., M.P.H., from Wake Forest, Holly Kramer, M.D., M.P.H., from Loyola Medical Center, Roger Blumenthal, M.D., from Johns Hopkins University School of Medicine, Michael Y. Tsai, Ph.D., from the University of Minnesota, and Bruce Psaty, M.D., Ph.D., M.P.H., from the University of Washington.
Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,187 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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