Abstract
Screening and treatment rates for dyslipidemia in populations at high risk for cardiovascular disease (CVD) are inappropriately low and rates among women may be lower than among men. We conducted a review of the literature for possible explanations of these observed gender differences and categorized the evidence in terms of a conceptual model that we describe. Factors related to physicians’ attitudes and knowledge, the patient’s priorities and characteristics, and the health care systems in which they interact are all likely to play important roles in determining screening rates, but are not well understood. Research and interventions that simultaneously consider the influence of patient, clinician, and health system factors, and particularly research that focuses on modifiable mechanisms, will help us understand the causes of the observed gender differences and lead to improvements in cholesterol screening and management in high-risk women. For example, patient and physician preferences for lipid and other CVD risk factor management have not been well studied, particularly in relation to other gender-specific screening issues, costs of therapy, and by degree of CVD risk; better understanding of how available health plan benefits interact with these preferences could lead to structural changes in benefits that might improve screening and treatment.
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References
American Heart Association. American Heart Association 2002 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2001:1–38.
Miettinen T, Pyorala K, Olsson A, et al. Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris. Circulation. 1997;96:4211–8.
McPherson R, Genest J, Angus C, Murray P. The Women’s Atorvastatin Trial on Cholesterol (WATCH): frequency of achieving NCEP-II target LDL-C levels in women with and without established CVD. Am Heart J. 2001;141:949–56.
LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–57.
Lewis S, Sacks F, Mitchell J, et al. Effect of pravastatin on cardiovascular events in women after myocardial infarction. The Cholesterol and Recurrent Events (CARE) trial. J Am Coll Cardiol. 1998;32:140–6.
Waters D, Higginson L, Gladstone P, Boccuzzi S, Cook T, Lesperance J. Effects of cholesterol lowering on the progression of coronary atherosclerosis in women: a Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) substudy. Circulation. 1995;92:2404–10.
Meigs J, Stafford R. Cardiovascular disease prevention practices by U.S. physicians for patients with diabetes. J Gen Intern Med. 2000;15:220–8.
Qureshi A, Suri M, Guterman L, Hopkins L. Ineffective secondary prevention in survivors of cardiovascular events in the U.S. population. Report from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2001;161:1621–8.
Saadine J, Engelgau M, Beckles G, Gregg E, Thompson T, Venkat-Narayan K. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.
Brown D, Giles W, Greenlund K, Croft J. Disparities in cholesterol screening: falling short of a national health objective. Prev Med. 2001;33:517–22.
Davis K, Cogswell M, Lee S, Rothenberg R, Koplan J. Lipid screening in a managed care population. Public Health Rep. 1998;113:346–51.
Pearson T. The undertreatment of LDL-cholesterol: addressing the challenge. Int J Cardiol. 2000:S23-28.
Pearson T, Laurora I, Chu H, Kafonek S. The Lipid Treatment Assessment Project (L-TAP). Arch Intern Med. 2000;160:459–67.
Gardner C, Winkleby M, Fortmann S. Population frequency distribution of non-high-density lipoprotein cholesterol (Third National Health and Nutrition Examination Survey, 1988–94). Am J Cardiol. 2000;86:299–304.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.
Ayanian J, Epstein A. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221.
Weintraub W, Kosinski A, Wenger N. Is there a bias against performing coronary revascularization in women? Am J Cardiol. 1996;78:1154–60.
Schulman K, Berlin J, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.
Roger V, Farkouh M, Weston S, et al. Sex differences in evaluation and outcome of unstable angina. JAMA. 2000;283:646–52.
Rathore S, Chen J, Wang Y, Radford M, Vaccarino V, Krumholz H. Sex differences in cardiac catheterization: the role of physician gender. JAMA. 2001;286:2849–56.
Alter D, Naylor C, Austin P, Tu J. Biology or bias. practice patterns and long-term outcomes for men and women with acute myocardial infarction. J Am Coll Cardiol. 2002;39:1909–16.
Ghali W, Faris P, Galbraith P, et al. Sex differences in access to coronary revascularization after cardiac catheterization: importance of detailed clinical data. Ann Intern Med., 2002;136:723–32.
Shaw L, Miller D, Romeis J, et al. Gender differences in the non-invasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med. 1991;120:559.
Janz N, Becker M. The Health Belief Model: a decade later. Health Educ Q. 1984;11:1–47.
Landon B, Wilson I, Cleary P. A conceptual model of the effects of health care organizations on the quality of medical care. JAMA. 1998;279:1377–82.
Jaen C, Stange K, Nutting P. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994;38:166–71.
Janes G, Blackman D, Bolen J, et al. Surveillance for use of preventive health-care services by older adults, 1995–97. Morb Mortal Wkly Rep CDC Surveill Summ. 1999;48:51–88.
Ayanian J, Weissman J, Schneider E, Ginsburg J, Zaslavsky A. Unmet health needs of uninsured adults in the United States. JAMA. 1998;284:2061–9.
Bindman A, Grumbach K, Osmond D, Vranizan K, Stewart A. Primary care and receipt of preventive services. J Gen Intern Med. 1996;11:269–76.
Corbie-Smith G, Flagg E, Doyle J, O’Brien M. Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. J Gen Intern Med. 2002;17:458–64.
Mainous A, Hueston W, Love M, Griffith C. Access to care for the uninsured: is access to a physician enough? Am J Public Health. 1999;89:910–2.
Lurie N, Manning W, Peterson C, Goldberg G, Phelps C, Lillard L. Preventive care: do we practice what we preach? Am J Public Health. 1987;77:801–4.
Ayanian J, Landon B, Landrum M, Grana J, McNeil B. Use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction. J Gen Intern Med. 2002;17:95–7.
Hueston W, Spencer E, Kuehn R. Differences in the frequency of cholesterol screening in patients with Medicaid compared with private insurance. Arch Fam Med. 1995;4:331–4.
Luepker R, Rosamond W, Murphy R, et al. Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey Circulation. 1993;88:2172–9.
Cooper G, Goodwin M, Stange K. The delivery of preventive services for patient symptoms. Am J Prev Med. 2001;21:177–81.
Stange K, Flocke S, Goodwin M, Kelly R, Zyzanski S. Direct observation of rates of preventive service delivery in community family practice. Prev Med. 2000;31:167–76.
Mosca L, Jones W, King K, Ouyang P, Redberg R, Hill M. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women’s Heart Disease and Stroke Campaign Task Force. Arch Fam Med. 2000;9:506–15.
Marvel M, Epstein R, Flowers K, Beckman H. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7.
Kaplan C, Siegel B, Madill J, Epstein A. Communication and the medical interview: strategies for learning and teaching. J Gen Intern Med. 1997: S49–55.
Hall J, Roter D. Patient gender and communication with physicians: results of a community-based study. Womens Health. 1995;1:77–95.
Elderkin-Thompson V, Waitzkin H. Differences in clinical communication by gender. J Gen Intern Med. 1999;14:112–21.
Roter D, Hall J, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA; 288:756–64.
Kaplan S, Gandek B, Greenfield S, Rogers W, Ware J. Patient and visit characteristics related to physicians’ participatory decision-making style. Med Care. 1995;33:1176–87.
Ayanian J, Landrum M, McNeil B. Use of cholesterol-lowering therapy by elderly adults after myocardial infarction. Arch Intern Med. 2002;162:1013–9.
Lemaitre R, Furberg C, Newman A, et al. Time trends in the use of cholesterol-lowering agents in older adults: the Cardiovascular Health Study. Arch Intern Med. 1998;158:1761–8.
Aronow W. Underutilization of lipid-lowering drugs in older persons with prior myocardial infarction and a serum low-density lipoprotein cholesterol >125 mg/dl. Am J Cardiol. 1998;82:668–9,A6,A8.
Di Cecco R, Patel U, Upshur R. Is there a clinically significant gender bias in post-myocardial pharmacological management in the older (>60) population of a primary care practice? BMC Fam Pract. 2002;3:8.
Laubach E, Otto C, Schwandt P. Toward better therapy of hypercholesterolemia. Arch Intern Med. 2000;160:2685–6.
Harris M. Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care. 2001;24:454–9.
Nelson K, Norris K, Mangione C. Disparities in the diagnosis and pharmacologic treatment of high serum cholesterol by race and ethnicity. Arch Intern Med. 2002;162:929–35.
Wisdom K, Fryzek J, Havstad S, Anderson R, Dreiling M, Tilley B. Comparison of laboratory test frequency and test results between African-Americans and Caucasians with diabetes: opportunity for improvement: findings from a large urban health maintenance organization. Diabetes Care. 1997;20:971–7.
Cook C, Erdman D, Ryan G, et al. The pattern of dyslipidemia among urban African-Americans with type 2 diabetes. Diabetes Care. 2000;23:319–24.
Maviglia S, Teich J, Fiskio J, Bates D. Using an electronic medical record to identify opportunities to improve compliance with cholesterol guidelines. J Gen Intern Med. 2001;16:531–7.
Winkleby M, Cubbin C, Ahn D, Kraemer H. Pathways by which SES and ethnicity influence cardiovascular risk factors. Ann N Y Acad Sci. 1999;896:191–209.
Miller M, Byington R, Hunninghake D, Pitt B, Furberg C. Sex bias and underutilization of lipid-lowering therapy in patients with coronary artery disease at academic medical centers in the United States and Canada. Arch Intern Med. 2000;160:343–7.
Majumdar S, Gurwitz J, Soumerai S. Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease. J Gen Intern Med. 1999;14:711–7.
McBride P, Schrott H, Plane M, Underbakke G, Brown R. Primary care practice adherence to National Cholesterol Program guidelines for patients with coronary heart disease. Arch Intern Med. 1998;158:1238–44.
Sloan K, Sales A, Willems J, et al. Frequency of serum low-density lipoprotein cholesterol measurement and frequency of results < 100 mg/dl among patients who had coronary events (Northwest VA Network Study). Am J Cardiol. 2001;88:1143–6.
Vanuzzo D, Pilotto L, Ambrosio G, et al. Potential for cholesterol lowering in secondary prevention of coronary heart disease in Europe: findings from EUROASPIRE study. Atherosclerosis. 2000;153:505–17.
The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA. 1995;273:199–208.
Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart Estrogen/Progestin Replacement Study (HERS) Res Group. JAMA. 1998;280:605–13.
Womens Health Initiative. Primary prevention with estrogen/progestin. JAMA. 2002.
Iezzoni L, McCarthy E, Davis R, Siebens H. Mobility difficulties are not only a problem of old age. J Gen Intern Med. 2001;16:235–43.
McTigue K, Garrett J, Popkin B. The natural history of the development of obesity in a cohort of young U.S. adults between 1981 and 1998. Ann Intern Med. 2002;136:857–64.
Kessler R, McGonagle K, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.
Iezzoni L, McCarthy E, Davis R, Siebens H. Mobility impairments and use of screening and preventive services. Am J Public Health. 2000;90:955–61.
Wee C, McCarthy E, Davis R, Phillips R. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000;132:697–704.
Garber M, Bergus G, Dawson J, Wood G, Levy B, Levin I. Effect of a patient’s psychiatric history on physicians’ estimation of probability of disease. J Gen Intern Med. 2000;15:204–6.
Phillips L, Branch W, Cook C, et al. Clinical inertia. Ann Intern Med. 2001;135:824–34.
Greenfield S, Kaplan S, Kahn R, Ninomiya J, Griffith J. Profiling care by different groups of physicians. effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med. 2002;136:111–21.
Orav E, Wright E, Palmer R, Hargraves J. Issues of variability and bias affecting multisite measurement of quality of care. Med Care. 1996:S87–101.
Sixma H, Spreeuwenberg P, van der Pasch M. Patient satisfaction with the general practitioner: a two-level analysis. Med Care. 1998;36:212–29.
Hofer T, Hayward R, Greenfield S, Wagner E, Kaplan S, Manning W. The unreliability of individual physician “report cards” for assessing the costs and quality of care of a chronic disease. JAMA. 1999;281:2098–105.
Krein S, Hofer T, Kerr E, Hayward R. Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups and healthcare facilities. Health Serv Res. 2002;27:1159–80.
Grover S, Lowensteyn I, Esrey K, et al. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ. 1995;310:975–8.
Birdwell B, Herbers J, Kroenke K. Evaluating chest pain. Arch Intern Med. 1993;153:1991–5.
Roger V, Jacobsen S, Weston S, et al. Sex differences in evaluation and outcome after stress testing. Mayo Clin Proc. 2002;77:638–45.
Ayanian J, Landrum M, Guadagnoli E, Gaccione P. Specialty of ambulatory care physicians and mortality among elderly patients after myocardial infarction. N Engl J Med. 2002;347:1678–86.
Stafford R, Blumenthal D. Specialty differences in cardiovascular disease prevention practices. J Am Coll Cardiol. 1998;32:1238–43.
Hyman D, Maibach W, Flora J, Fortmann S. Cholesterol treatment practices of primary care physicians. Public Health Rep. 1992;107:441–8.
Marcelino J, Feingold K. Inadequate treatment with HMG-CoA reductase inhibitors by health care providers. Am J Med. 1996;100:605–10.
Wyn R, Brown E, Yu H. Women’s Use of Preventive Services: The Commonwealth Fund Survey. Baltimore, MD: Johns Hopkins University Press; 1996.
Henderson J, Weisman C, Grason H. Are two doctors better than one? Women’s physician use and appropriate care. Womens Health Issues. 2002;12:138–49.
Giles W, Anda R, Jones D, Serdula M, Merritt R, DeStefano F. Recent trends in the identification and treatment of high blood cholesterol by physicians. Progress and missed opportunities. JAMA. 1993;269:1133–8.
Stange K, Fedirko T, Zyzanski S, Jaen C. How do family physicians prioritize delivery of multiple preventive services? J Fam Pract. 1994;38:231–7.
Osuch J, Bonham V, Morris L. Primary care guide to managing a breast mass: step-by-step work-up. Medscape Womens Health. 1998;3:4.
Barratt A, Cockburn J, Furnival C, McBride A, Mallon L. Perceived sensitivity of mammographic screening: women’s views on test accuracy and financial compensation for missed cancers. J Epidemiol Community Health. 1999;53:716–20.
Henderson J, Weisman C. Physician gender effects on preventive screening and counseling: an analysis of male and female patients’ health care experiences. Med Care. 2001;39:1281–92.
Cassard S, Weisman C, Plichta S, Johnson T. Physician gender and women’s preventive services. J Womens Health., 1997;6:199–207.
Franks P, Clancy C. Physician gender bias in clinical decision making: screening for cancer in primary care. Med Care. 1993;31:213–8.
Schwartz J, Lewis C, Clancy C, Kinosian M, Radany M, Koplan J. Internists’ practices in health promotion and disease prevention. A Survey. Ann Intern Med. 1991;114:46–53.
Dresselhaus T, Peabody J, Lee M, Wang M, Luck J. Measuring compliance with preventive care guidelines. J Gen Intern Med. 2000;15:782–8.
Harnick D, Cohen J, Schechter C, Fuster V, Smith D. Effects of practice setting on quality of lipid-lowering management in patients with coronary artery disease. Am J Cardiol. 1998;81:1416–20.
DeBusk R, Miller N, Superko H, et al. Case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994;120:721–9.
Bramlet D, King H, Young L, Witt J, Stoukides C, Kaul A. Management of hypercholesterolemia: practice patterns for primary care providers and cardiologists. Am J Cardiol. 1997: 39H–44H.
McAlister F, Lawson F, Teo K, Armstrong P. Randomised trials of secondary prevention programs in coronary heart disease: systematic review. BMJ. 2001;323:957–62.
LaBresh K, Owen P, Alteri C, et al. Secondary prevention in a cardiology group practice and hospital setting after a heart-care initiative. Am J Cardiol 2000;85:23A-29A.
Evenson K, Rosamond W, Luepker R. Predictors of outpatient cardiac rehabilitation utilization: the Minnesota Heart Surgery Registry. J Cardiopulm Rehabil. 1998;18:192–8.
Blackburn G, Foody J, Sprecher D, Park E, Apperson-Hansen C, Pashkow F. Cardiac rehabilitation participation patterns in a large, tertiary care center: evidence for selection bias. J Cardiopulm Rehabil. 2000;20:189–95.
Mosca L, Han R, Filip J. Barriers for physicians to refer to cardiac rehabilitation and impact of a critical care pathway on rates of participation. Circulation 1998:I-811. Abstract.
Stange K, Zyzanski S, Smith T, et al. How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits. Med Care. 1998;36:851–67.
Kerr E, Krein S, Vijan S, Hofer T, Hayward R. Avoiding pitfalls in chronic disease quality management: a case for the next generation of technical quality measures. Am J Manag Care. 2001;7:1033–43.
Luck J, Peabody J, Dresselhaus T, Lee M, Glassman P. How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record. Am J Med. 2000;108:642–9.
Bloom S, Harris J, Thompson B, Ahmed F, Thompson J. Tracking clinical preventive service use: a comparison of the Health Plan Employer Data and Information Set with the Behavioral Risk Factor Surveillance System. Med Care. 2000;38:187–94.
Peabody J, Luck J, Glassman P, Dresselhaus T, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283:1715–22.
Headrick L, Speroff T, Pelecanos H, Cebul R. Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial. Arch Intern Med. 1992;152:2490–6.
Schechtman J, Kanwal N, Schroth W, Elinsky E. The effect of an education and feedback intervention on group-model and network-model health maintenance organization physician prescribing behavior. Med Care. 1995;33:139–44.
Mainous A, Hueston W, Love M, Evans M, Finger R. An evaluation of statewide strategies to reduce antibiotic overuse. Fam Med. 2000;32:22–9.
Balas E, Boren S, Brown G, Ewigman B, Mitchell J, Perkoff G. Effect of physician profiling on utilization: meta-analysis of randomized clinical trials. J Gen Intern Med. 1996;11:584–90.
Renders C, Valk G, Franse L, Schellveis F, Van Eijk J, van der Wal G. Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice. Diabetes Care. 2001;24:1365–70.
Baker A, Lafata J, Ward R, Whitehouse F, Divine G. A web-based diabetes care management support system. Jt Comm J Qual Improv. 2001;27:179–90.
Peters A, Davidson M. Application of a diabetes managed care program. The feasibility of using nurses and a computer system to provide effective care. Diabetes Care. 1998;21:1037–43.
Rubin R, Kietrich K, Hawk A. Clinical and economic impact of implementing a comprehensive diabetes management program in managed care. J Clin Endocrinol Metab. 1998;83:2635–42.
Domurat E. Diabetes managed care and clinical outcomes: the Harbor City, California Kaiser Permanente Diabetes Care System. Am J Manag Care. 1999;5:1299–307.
Renders C, Valk G, Griffin S, Wagner E, Eijk van J, Assendelft W. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 2001;24:1821–33.
Centers for Disease Control and Prevention and Health. Heart Disease and Stroke. Healthy People 2010-Conference Edition 1999. Bethesda, MD: United States Public Health Service; 1999.
National Heart Lung and Blood Institute. Strategic Plan FY 2002–06. Rockville, MD: National Institutes of Health; 2002. http://www.nhlbi.nih.gov/resources/docs/plan/index.htm/; accessed on April 1, 2003.
Mangione C, Reynolds E. Disparities in health and health care. J Gen Intern Med. 2001;16:276–80.
Weisse C, Sorum P, Sanders K, Syat B. Do gender and race affect decisions about pain management? J Gen Intern Med. 2001;16:211–7.
Chapman K, Tashkin D, Pye D. Gender bias in the diagnosis of COPD. Chest. 2001;119:1691–5.
Watson R, Stein A, Dwamena F, et al. Do race and gender influence the use of invasive procedures? J Gen Intern Med. 2001;16:227–34.
Raine R. Does gender bias exist in the use of specialist health care? J Health Serv Res Policy. 2000;5:237–49.
Johnson M, Lin M, Mangalik S, Murphy D, Kramer A. Patients’ perceptions of physicians’ recommendations for comfort care differ by patient age and gender. J Gen Intern Med. 2000;15:248–55.
Majeed Z, Moser K, Maxwell R. Age, sex, and practice variations in the use of statins in general practice in England and Wales. J Public Health Med. 2000;22:275–9.
Savoie I, Kazanjian A. Utilization of lipid-lowering drugs in men and women: a reflection of the research evidence? J Clin Epidemiol. 2002;55:95–101.
Hippisley-Cox J, Pringle M, Crown N, Meal A, Wynn A. Sex inequalities in ischaemic heart disease in general practice: cross-sectional survey. BMJ. 2001;322:832.
Bowker T, Clayton T, Ingham J, et al. British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events). Heart. 1996;75:334–42.
Bannerman A, Hamilton K, Isles C, et al. Myocardial infarction in men and women under 65 years of age: no evidence of gender bias. Scott Med J. 2001;46:73–8.
Wei L, Wang J, Thompson P, Wong S, Struthers A, Macdonald T. Adherence to statin treatment and readmission of patients after myocardial infarction: a six year follow-up study. Heart. 2002;88:229–33.
Sgadari A, Incalzi R, Onder G, Pedone C, Cambassi G. Lipid-lowering therapy in patients with coronary artery disease: sex or age bias? Arch Intern Med. 2000;160:2684–5.
Pilote L, Beck C, Richard H, Eisenberg M. The effects of cost-sharing on essential drug prescriptions, utilization of medical care and outcomes after acute myocardial infarction in elderly patients. CMAJ. 2002;167:246–52.
Evenson K, Fleury J. Barriers to outpatient cardiac rehabilitation participation and adherence. J Cardiopulm Rehabil. 2000;20:241–6.
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Dr. Kim is supported by an American Diabetes Association Junior Faculty Award. Dr. Kerr is supported by an Advanced Research Career Development Award from the Department of Veterans Affairs Health Services Research and Development Service. Dr. Hofer is supported by grant 1P20HS011540-01 from the Agency for Health Research and Quality.
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Kim, C., Hofer, T.P. & Kerr, E.A. Review of evidence and explanations for suboptimal screening and treatment of dyslipidemia in women. J GEN INTERN MED 18, 854–863 (2003). https://doi.org/10.1046/j.1525-1497.2003.20910.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.20910.x