Appropriateness of Cholesterol Management in Primary Care by Sex and Level of Cardiovascular Risk
Open Access
- 26 March 2009
- journal article
- research article
- Published by Wiley in Preventive Cardiology
- Vol. 12 (2), 95-101
- https://doi.org/10.1111/j.1751-7141.2008.00019.x
Abstract
A study was undertaken to ascertain the appropriateness of lipid screening and management per the Third Report of the Adult Treatment Panel National Cholesterol Education Program (ATP III) guideline in a sample of North Carolina primary care practices. Demographics, cholesterol values, and comorbid conditions were abstracted from the medical records from 60 community practices participating in a randomized practice‐based trial (Guideline Adherence for Heart Health). Eligible patients were aged 21 to 84 years, seen during the baseline period of June 1, 2001, through May 31, 2003, and who were not taking lipid‐lowering therapy. Multivariable logistic regression was utilized to assess whether age, sex, race/ethnicity, diabetes, cardiovascular disease, ATP III risk category, or pretreatment low‐density lipoprotein (LDL) influenced treatment. Among 5031 eligible patients, 1711 (34.5%) received screening lipid profiles. Screening rates were higher with older age, diabetes, and cardiovascular disease. No large differences were seen by sex. Among patients screened (mean age, 51.6 years; 57.9% female), 76.6% were appropriately managed within 4 months. In adjusted analyses, older age was associated with less appropriate treatment (odds ratio [OR] per 5 years, 0.91; P=.01), and patients with LDL cholesterol ≤130 mg/dL (OR, 18.8; P<.001) and the low‐risk group (OR, 27.5; P<.001) were more likely to be managed appropriately compared with patients with LDL ≥190 mg/dL and those at high risk. Among 375 patients eligible for drug treatment, those with LDL levels between 131 and 159 mg/dL were much less likely to be treated (OR, 0.15; P<.001) compared with those with LDL >190 mg/dL, whereas risk category did not influence treatment. The challenge facing implementation of ATP III guidelines is much greater for intermediate‐ and high‐risk patients than for low‐risk patients.Keywords
This publication has 34 references indexed in Scilit:
- Heart Disease and Stroke Statistics—2006 UpdateCirculation, 2006
- Dyslipidemia Prevalence, Treatment, and Control in the Multi-Ethnic Study of Atherosclerosis (MESA)Circulation, 2006
- National Trends in Statin Use by Coronary Heart Disease Risk CategoryPLoS Medicine, 2005
- Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III GuidelinesJournal of the American College of Cardiology, 2004
- Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III GuidelinesCirculation, 2004
- Quality of care for secondary prevention for patients with coronary heart disease: results of the Hastening the Effective Application of Research through Technology (HEART) trialAmerican Heart Journal, 2003
- Management of Hypercholesterolemia: Practice Patterns for Primary Care Providers and CardiologistsThe American Journal of Cardiology, 1997
- Low incidence of assessment and modification of risk factors in acute care patients at high risk for cardiovascular events, particularly among females and the elderlyThe American Journal of Cardiology, 1995
- Recent trends in the identification and treatment of high blood cholesterol by physicians. Progress and missed opportunitiesJAMA, 1993
- Hypercholesterolemia prevalence, awareness, and treatment in blacks and whites: The Minnesota heart surveyPreventive Medicine, 1989