Atherosclerosis in a managed care plan: hypercholesterolemia treatment patterns and low-density lipoprotein cholesterol monitoring

Abstract

Clinical guidelines have recommended a LDL-C goal of <100 mg/dL for high-risk individuals and lipid-modifying therapy for patients not reaching this goal. This investigation assessed low-density lipoprotein cholesterol (LDL-C) levels and treatment patterns among patients diagnosed with atherosclerosis with or without a previous cardiovascular disease (CVD) event. We conducted a retrospective study by using claims data from a national health plan that included patients with ≥ 1 medical claim for atherosclerosis (ICD-9 of 440.xx, 414.x, 437.0, 437.1, or 437.3) between January 2004 and March 2006. Use of lipid-modifying medications at the time of diagnosis and thereafter, patient demographics, comorbid conditions, baseline, and postdiagnosis LDL-C were assessed. There were 311,567 patients who had an atherosclerosis ICD-9 code, 46% of whom had a previous CVD event. Among patients with an atherosclerosis diagnosis and CVD event, lipid-modifying therapy was received by 50% before diagnosis and 57% after diagnosis, compared with 37% before and 48% after diagnosis for patients with an atherosclerosis diagnosis and no previous CVD event. Of the patients with baseline LDL-C (15%, n=46,923), 44% had an LDL-C <100mg/dL at diagnosis; of those with LDL-C ≥ 100mg/dL, only 54% received lipid-modifying therapy and only 64% achieved an LDL-C <100mg/dL in the 12 succeeding months. Among patients with baseline and postdiagnosis LDL-C values (n=24,724), 55% had a baseline LDL-C ≥ 100mg/dL and 46% had a baseline non-HDL-C ≥ 130mg/dL. In conclusion, many patients in a managed care plan diagnosed with atherosclerosis with or without a previous CVD event present opportunities for better lipid management. Healthcare providers should evaluate more aggressive lipid management interventions for these patients for potential downstream cardiovascular benefits.