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(Circulation. 2005;111:488-493.)
© 2005 American Heart Association, Inc.

Cardiovascular Disease in Women

Opportunity for Intervention to Achieve American Heart Association Guidelines for Optimal Lipid Levels in High-Risk Women in a Managed Care Setting

Lori Mosca, MD, MPH, PhD; Noel Bairey Merz, MD; Roger S. Blumenthal, MD; Mark J. Cziraky, PharmD; Rosalind P. Fabunmi, PhD; Chaitanya Sarawate, MS; Karol E. Watson, MD; Vincent J. Willey, PharmD; Eric J. Stanek, PharmD

From Columbia University, New York, NY (L.M.); Cedars-Sinai Medical Center, Los Angeles, Calif (N.B.); Johns Hopkins Medical Institute, Baltimore, Md (R.S.B.); HealthCore, Inc, Wilmington, Del (M.J.C., C.S., V.J.W.); American Heart Association, Dallas, Tex (R.P.F.); University of California, Los Angeles, Los Angeles, Calif (K.E.W.); and Kos Pharmaceuticals, Inc, Weston, Fla (E.J.S.).

Correspondence to Dr Lori Mosca, Preventive Cardiology, New York–Presbyterian Hospital, 622 W 168th St, PH10-203B, New York, NY 10032. E-mail ljm10{at}columbia.edu

Received December 1, 2004; accepted December 13, 2004.

Background— The American Heart Association (AHA) recently established evidence-based recommendations for cardiovascular disease (CVD) prevention in women, including lipid management. This study evaluated optimal lipid-level attainment and treatment patterns on the basis of these guidelines in high-risk women in a managed care setting.

Methods and Results— We conducted a historical prospective cohort analysis of a 1.1-million-member, integrated, managed-care database. Eligible high-risk women were those with evidence of previous CVD or risk equivalent who had a full lipid panel available between October 1, 1999, and September 30, 2000; were naive to lipid therapy; and had a minimum of 12 months health plan eligibility preindex and postindex lipid panel. Optimal lipid levels were defined as LDL cholesterol (LDL-C) <100 mg/dL, HDL cholesterol (HDL-C) >50 mg/dL, non–HDL-C <130 mg/dL, and triglycerides <150 mg/dL. Laboratory values and lipid pharmacotherapy were assessed longitudinally over the postindex follow-up (up to 36 months). A total of 8353 high-risk women (mean age, 66±14 years) with a mean follow-up of 27±8 months were included. Only 7% attained optimal combined lipid levels initially, and this increased to 12% after 36 months. Lipid-modifying therapy was initiated in 32% of patients, including 35% of women with LDL-C 100 mg/dL and 15% with LDL-C <100 mg/dL.

Conclusions— Among high-risk women, few attained the AHA’s standards for all lipid fractions, and only one third received recommended drug therapy, highlighting significant opportunities to apply evidence-based recommendations to manage lipid abnormalities in high-risk women.

Key Words: women • lipids • lipoproteins • cardiovascular diseases • cholesterol

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