Underutilization of measurement of serum low-density lipoprotein cholesterol levels and of lipid-lowering therapy in older patients with manifest atherosclerotic disease.

Abstract

To investigate the prevalence of measurement of serum lipids and of utilizing lipid-lowering therapy, when appropriate, in older persons without contraindications to lipid-lowering drugs and with myocardial infarction (MI), stroke, peripheral arterial disease (PAD), and no coronary artery disease (CAD), stroke, or PAD. A retrospective analysis of charts of all older patients seen from January 1, 1997, through October 15, 1997, was performed to investigate the prevalence of measurement of serum lipids and utilization of lipid-lowering therapy, when appropriate, in older persons without contraindications to lipid-lowering drugs and with MI, stroke, PAD, and no CAD, stroke, or PAD. Patients with life-limiting comorbidities were not included in the study. An academic, hospital-based geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. A total of 373 men and 1119 women, mean age 80 +/- 8 years (range 59 to 103 years), were included in the study. Serum low-density lipoprotein (LDL) cholesterol was measured in 201 of 391 patients (51%) with MI, in 78 of 187 patients (42%) with stroke, in 58 of 115 patients (50%) with PAD, and in 396 of 926 patients (43%) with no CAD, stroke, or PAD. In patients with elevated serum LDL cholesterol levels, lipid-lowering drug therapy was given to eight of 15 patients (53%) <70 years of age with MI, to 34 of 63 patients (54%) 70 to 80 years of age with MI, and to 38 of 81 patients (47%) >80 years of age with MI (P not significant); to three of seven patients (43%) <70 years of age with stroke, to 12 of 26 patients (46%) 70 to 80 years of age with stroke, and to 13 of 32 patients (41%) >80 years of age with stroke (P not significant); to two of four patients (50%) <70 years of age with PAD, to seven of 17 patients (41%) 70 to 80 years of age with PAD, and to 10 of 25 patients (40%) >80 years of age with PAD (P not significant); and to six of 15 patients (40%) <70 years of age with no CAD, stroke, or PAD, to 26 of 70 patients (37%) 70 to 80 years of age with no CAD, stroke or PAD, and to 14 of 47 patients (30%) >80 years of age with no CAD, stroke, or PAD (P not significant). None of the other patients with MI, stroke, PAD, or no CAD, stroke, or PAD was treated with diet or lipid-lowering drugs. Measurement of serum LDL cholesterol and of appropriate use of lipid-lowering drugs and diet in older patients with MI, stroke, PAD, and no CAD, stroke, or PAD is underutilized in an academic, hospital-based geriatrics practice.