Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting

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 greater than or equal to100 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.