Abstract 4160: Time Trends in Lipid Management: Is the Gender Gap Closing?
Introduction Gender differences in cardiovascular disease (CVD) preventive care have previously been shown. We hypothesized that the gender gap in lipid management would narrow after publication of AHA Evidence-based Guidelines for Prevention of CVD in Women.
Methods: We conducted a US health plan retrospective study using claims data from 1999 to 2005. Patients were ≥18 years with CVD or diabetes (N = 33,804; 50% female; mean age 60 ± 13 years), had a full-panel lipid test in pre-guideline (9/02- 2/04) and post-guideline (3/04 - 8/05) periods, and were eligible 12-months pre- and 4-months post-index date of full lipid panel. Outcomes were: % of subjects at LDL goal (conservative <100 or aggressive < 70 mg/dL), HDL < 50 mg/dL, triglycerides < 150 mg/dL, and combined aggressive goals. Within gender change over time and between gender differences, pre- and post-guideline release were analyzed using Pearson’s chi-square and logistic regression.
Results: Both men and women showed significant improvement in LDL goal attainment over time, but men had better control in both time periods (table⇓). At the most recent evaluation, women were significantly less likely to have LDL < 100 compared to men (OR .68; 95% CI .65 - .71). The differential between men and women attaining LDL goals did not narrow over time. Women were more likely than men to meet HDL and TG standards in both time periods with minimal change over time. At most recent evaluation, ≤ 50% of patients were at a conservative LDL goal and ≤ 4% were at combined goals for aggressive LDL, HDL and triglycerides. Women were significantly more likely to attain combined lipid goals than men (OR=1.49, 95% CI = 1.32–1.68).
Conclusions: Lipid control is suboptimal for high risk men and women. Patterns before and after the 2004 AHA Women’s Guidelines suggest the gender gap in lipid management is not narrowing. These data suggest reasons for non-adherence to guidelines and sex-based disparities in preventive care need further study.