Abstract P66: Factors Associated With Treatment With Antihyperlipidemic Agents in Patients With Cardiovascular Disease: Evidence From the National Health and Nutrition Examination Survey (NHANES)

Abstract

Background Despite widespread acceptance of NCEP guidelines, the extent of treatment of hyperlipidemia in patients with cardiovascular disease (CVD) remains poor. This analysis investigated factors associated with treatment with antihyperlipidemic agents in a US representative cohort of patients with evidence of CVD. Methods We used the 2005-2006 NHANES to explore the research question of interest. Self reports of physician diagnosis indicating the presence of coronary heart disease, myocardial infarction, angina, congestive heart failure, or stroke served as evidence of established CVD. We used multivariate logistic regression to examine factors independently associated with current antihyperlipidemic treatment, maintaining factors in the final model if p<0.15. Results Nearly 50% of the 561 subjects with established CVD were not taking any antihyperlipidemic agents. Compared with those not receiving treatment, greater percentage of those treated were male (58.8% vs. 42.2%), non-Hispanic whites (84.8% vs. 71.7%), aged 55-74 (56.3% vs. 30.4%), holders of private insurance (57.3% vs. 52.2%), Medicare insured (65.8% vs. 50.5%), and obese (47.4% vs. 39.4%). Greater percentage of untreated patients was African American (15.1% vs. 10.4%), had a break in their health insurance coverage in past 12 months (21.9% vs. 7.0%) & was current smoker (29.4% vs. 15.2%). In multivariate results, the following factors remained significantly associated (OR [95%CI]) with treatment: male gender (1.89 [1.06 -3.39]), White race (2.45 [1.53 - 3.95]), older age (P < 0.0001), high school education compared with less than 9 th grade education (2.53 [1.35 - 4.71]), and anti-diabetic treatment (3.31 [2.20 - 4.99]). Conclusion Treatment with antihyperlipidemic agents in patients with CVD are related to individual (behavioral) and contextual (institutional, structural) factors. Further investigation is required to understand unmeasured factors associated with treatment initiation and to develop and test appropriate behavioral and contextual interventions to remove barriers to treatment initiation. Younger age groups, women, individuals with education < 9 th grade and racial/ethnic minorities who have CVD should especially be the target of such intervention.