Recently, several groups, including the Adult Treatment Panel III (ATPIII) and the American College of Cardiology/American Heart Association (ACC/AHA), have released updated cholesterol treatment guidelines. These guidelines are intended to influence cholesterol treatment practices for physicians, but few studies have documented their effect on actual prescribing behaviors and its impact on patient eligibility for treatment.
The ACC/AHA guidelines, for example, recently expanded its indications on who is recommended to receive statins, particularly patients who were previously thought to be at moderate risk of cardiovascular disease (CVD). The purpose of the new guidelines was to facilitate treatment decisions so that more eligible patients were prescribed these medications.
Women Vs Men
“Prior research has shown that women do not reliably receive aggressive cardiovascular interventions and may not be given guideline-based treatment in order to reduce their risk for cardiac events,” says Martin W. Schoen, MD, MPH. To address this issue, Dr. Schoen and colleagues had a study published in the American Journal of Cardiology that described cholesterol treatment in an academic practice of family and internal medicine physicians. The purpose was to understand factors that were associated with achieving guideline-based treatment goals in women as compared with men.
For the analysis, the investigators assessed primary care patients aged 40 to 75 who were either prescribed a statin, had a Framingham risk score of 10% or higher, had diabetes, or had atherosclerotic CVD. Patients were classified into ATPIII categories and assessed for whether or not they were in compliance with ATPIII guidelines. The authors then calculated odds ratios of goal adherence between women and men and developed a multivariate model for goal achievement.
Of the 2,747 patients involved in the study, researchers found that women were less likely to achieve cholesterol goals despite having more prescriptions for statins (48% vs 39%). More women than men failed to reach LDL goals because they were not prescribed a statin and women on high-intensity statins were less likely than men to achieve goals. In all patients, diabetes was associated with non-attainment of cholesterol goals. However, the presence of diabetes improved goal achievement among high-risk women.
“Our findings suggest that women achieve guideline-based cholesterol recommendations at a lower rate than men, even when individual goals are considered,” says Dr. Schoen. “As clinicians, we need to assess cardiovascular risk in all of our patients, but especially in women, to ensure that they receive appropriate treatment to improve their CVD risk. This information could be incorporated into electronic health records so that physicians are more vigilant when caring for women. Doing so is critical to reducing the burden of CVD and its outcomes for this patient population in the future.”
Martin W. Schoen, MD, MPH, is a Resident Physician in the Department of Internal Medicine at Saint Louis University School of Medicine.
Martin W. Schoen, MD, MPH, has indicated to Physician’s Weekly that he has no financial relationships that are relevant to this feature story.
Readings & Resources (click to view)
Schoen MW, Tabak RG, Salas J, Scherrer JF, Buckhold FR. Comparison of adherence to guideline-based cholesterol treatment goals in men versus women. Am J Cardiol. 2015 Oct 16 [Epub ahead of print]. Available at: http://www.ajconline.org/article/S0002-9149(15)02080-9/fulltext.
Schoen MW, Salas J, Scherrer JF, Buckhold FR. Cholesterol treatment and changes in guidelines in an academic medical practice. Am J Med. 2015;128:403-409.
Maddox TM, Borden WB, Tang F, et al. Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol. 2014;64:2183-2192.
Johnson KM, Dowe DA. Accuracy of statin assignment using the 2013 AHA/ACC Cholesterol Guideline versus the 2001 NCEP ATP III guideline: correlation with atherosclerotic plaque imaging. J Am Coll Cardiol. 2014;64:910-919.