Abstract
BackgroundReasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.MethodsWe studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.ResultsTime to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.ConclusionsBlack women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.
Highlights
Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy
Reducing low density lipoprotein (LDL) cholesterol to levels set by National Cholesterol Education Program Adult Treatment Panel (ATP) III guidelines decreases the risk of death from cardiovascular disease [1] and is cost-effective [2]
Among primary care patients at increased risk of cardiovascular disease because of hypertension and elevated LDL cholesterol, we hypothesized that race and gender differences in achieving LDL control would be reduced after accounting for lipid-lowering drug potency and baseline LDL values
Summary
Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL. Most studies of racial differences in achieving LDL control have been cross-sectional and do not consider the potency of prescribed lipid-lowering drugs [6,7,8]. Among primary care patients at increased risk of cardiovascular disease because of hypertension and elevated LDL cholesterol, we hypothesized that race and gender differences in achieving LDL control would be reduced after accounting for lipid-lowering drug potency and baseline LDL values
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