Effect of Gender, Caregiver, on Cholesterol Control and Statin Use for Secondary Prevention Among Hospitalized Patients With Coronary Heart Disease

Abstract

Women with coronary heart disease (CHD) are consistently less likely than men with CHD to be at low-density lipoprotein (LDL) cholesterol goals, and the reasons for the gender gap are not established. We studied 2,190 patients with CHD or equivalent (34% women, 42% racial/ethnic minority) who participated in the Family Cardiac Caregiver Investigation to Evaluate Outcomes (FIT-O) Study and had baseline lipid data to determine whether having a paid or informal caregiver was independently associated with adherence to LDL cholesterol goals (<100, <70 mg/dl) and statin use and to determine if the association varied by gender. Caregiver status was assessed by standardized questionnaire and lipid levels/statin use were obtained from a hospital-based informatics system. Associations between caregiving and LDL cholesterol and statin use were assessed in univariate and multivariable models and the interaction was evaluated in gender stratified models. Men with CHD were more likely to be at LDL cholesterol goals <100 and <70 mg/dl and on statins than women with CHD (79% vs 69%, p <0.001; 48% vs 36%, p <0.001; 73% vs 67%, p = 0.004, respectively). No significant association was observed between LDL cholesterol <100 mg/dl and informal caregiving or between paid caregiving and lipid goals or statin use. Having an informal caregiver was associated with having an LDL cholesterol <70 mg/dl (p = 0.016), which remained significant after adjustment in multivariable models (odds ratio 1.25, 95% confidence interval 1.00 to 1.56). Multivariable association between informal caregiving and LDL cholesterol was significant in men (odds ratio 1.37, 95% confidence interval 1.04 to 1.80) but not women. In conclusion, there was a significant association between informal caregiving and LDL cholesterol control that was limited to men with informal caregivers.