Abstract 3862: Implications of the NCEP ATP III Update on LDL-C Goal Attainment Among Elderly Patients
The NCEP ATP III Update (2004) introduced optional LDL-C goals of < 70 mg/dL and < 100 mg/dL for patients at very high and moderately high CHD risk, respectively. This study examined 1) the proportion of elderly (aged 65 or older) patients newly initiating statin therapy who attained the lower optional (optimal) or minimal LDL-C goals pre and post the Update; 2) the proportion that were treated with aggressive (expected LDL-C reduction ≥ 40%) vs. standard lipid lowering therapy. The study used data from Kaiser Permanente Northwest (KPNW), a group-model HMO that employs clinical practice guidelines to assist clinicians in patient management. We used dispense records to identify elderly patients who were newly initiated statin therapy in 2003 or 2005. Patients were categorized by CHD risk based on the Update (low, moderate, moderately high, high, and very high). Goal attainment was evaluated 6 months after initiation of therapy. Over 90% of patients were at moderately high, high or very high risk in each cohort year; 86% of these were not at optimal goal at baseline. The table⇓ below shows that optimal goal attainment for these patients was higher in 2005 vs. 2003 (57.5% vs. 51.5%, p = 0.003) with the greatest improvement occurring in the very high risk group. Aggressive treatment was uncommon in both cohorts, but was greater in 2005. Among very high-risk patients, 6.4% initiated therapy with aggressive treatment in 2003 vs. 11.6% in 2005 (p =.037). Within 6 months, 8.2% and 18.7%, respectively, had titrated to aggressive therapy (p =.0003). Although the ATP III Update appeared to positively impact LDL-C treatment and goal attainment, over half of very high and moderately high-risk patients, and over one-third of all patients did not attain optimal goals within 6 months. Even in an HMO employing clinical practice guidelines, most patients were not treated aggressively. Intensification of lipid lowering therapy may further improve goal attainment and reduce CHD risk among these patients.