“The most recent national guidelines from the American College of Cardiology/American Heart Association have expanded previous recommendations for reducing cholesterol to include lifestyle modifications and medication use as part of complete cholesterol management and to lower risk for atherosclerotic CVD,” says Carla Mercado, PhD. “A better understanding of the previous disparities in cholesterol care and medication use is important, particularly as more physicians begin implementing the most recent national guidelines.”

For a study published in the Morbidity & Mortality Weekly Report, Dr. Mercado and colleagues sought to determine baseline estimates of U.S. adults who were on or eligible for cholesterol treatment and to identify sex and racial/ethnic disparities. The investigators analyzed data from the 2005-2012 National Health and Nutrition Examination Surveys. Adults who met guideline eligibility criteria and those who were currently taking cholesterol-lowering drugs were assessed as a group.

Assessing the Data

“Our results indicated that about one third of all U.S. adults aged 21 or older—or 78.1 million—were on cholesterol treatment or eligible for it,” says Dr. Mercado. “However, only 55% of eligible adults were actually taking cholesterol-lowering drugs and about 47% reported making lifestyle modifications to lower cholesterol, such as exercising, making dietary changes, or controlling weight. Approximately 37% reported making lifestyle modifications and taking medication, but 36% reported doing neither.”

The study included all types of cholesterol-lowering drugs, but nearly 90% of those on medication were taking a statin. Of the nearly 41% of men who were eligible for or already on cholesterol medication, close to 53% were taking them. Among women, these figures were approximately 33% and 58%, respectively.

The proportion of eligible patients taking cholesterol-lowering medication was higher for non-Hispanic whites than Mexican-Americans and non-Hispanic blacks. The lowest rate of taking a recommended cholesterol medication was among non-Hispanic blacks who did not have a regular place for healthcare. The highest rate was seen in people reporting that they already adopted a heart-healthy lifestyle.

Greater Efforts Needed

“Our study suggests that there are opportunities to reduce disparities with targeted patient education and cholesterol management programs among adults who are eligible for cholesterol treatments,” Dr. Mercado says. “There is also room for improvements in cholesterol screening practices.”

The study notes that the CDC and other organizations are promoting initiatives to reduce disparities, including activities like Healthy People 2020 and the Million Hearts initiative. These programs provide clinicians with comprehensive and effective management strategies to improve cholesterol levels among Americans. The CDC also notes that coordinated community and clinical programs are needed to better identify all people who are now eligible for cholesterol treatment.

Carla Mercado, PhD, has indicated to Physician’s Weekly that she has no financial disclosures to report.

References

Mercado C, DeSimone AK, Odom E, Gillespie C, Ayala C, Loustalot F. Prevalence of cholesterol treatment eligibility and medication use among adults–United States, 2005-2012. MMWR. 2014;64:1305-1311. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6447a1.htm?s_cid=mm6447a1_w.

Frieden TR, Berwick DM. The “Million Hearts” initiative—preventing heart attacks and strokes. N Engl J Med. 2011;365:e27.

Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370:1422-1431.

Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960-2984.