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Ambulatory hypercholesterolemia management in patients with atherosclerosis

Gender and race differences in processes and outcomes

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Abstract

OBJECTIVE: To determine whether outpatient cholesterol management varies by gender or race among patients with atherosclerosis, and assess factors related to subsequent cholesterol control.

DESIGN: Retrospective cohort study.

SETTING: Primary care clinics affiliated with an academic medical center.

PARTICIPANTS: Two hundred forty-three patients with coronary heart disease, cerebrovascular disease, or peripheral vascular disease and low-density lipoprotein cholesterol (LDL-C)> 130 mg/dl.

MEASUREMENTS AND MAIN RESULTS: The primary process of care assessed for 1,082 office visits was cholesterol management (medication intensification or LDL-C monitoring). Cholesterol management occurred at 31.2% of women’s and 38.5% of men’s visits (P=.01), and 37.3% of black and 31.7% of white patients’ visits (P=.09). Independent predictors of cholesterol management included female gender (adjusted risk ratio [ARR], 0.77; 95% confidence interval [CI], 0.60 to 0.97), seeing a primary care clinician other than the patient’s primary care physician (ARR, 0.23; 95% CI, 0.11 to 0.45), and having a new clinical problem addressed (ARR, 0.60; 95% CI, 0.48 to 0.74). After 1 year, LDLC <130 mg/dl occurred less often for women than men (41% vs 61%; P=.003), black than white patients (39% vs 58%; P=.01), and patients with only Medicare insurance than with commercial insurance (37% vs 58%; P=.008). Adjustment for clinical characteristics and management attenuated the relationship between achieving an LDL-C <130 mg/dl and gender.

CONCLUSIONS: In this high-risk population with uncontrolled cholesterol, cholesterol management was less intensive for women than men but similar for black and white patients. Less intense cholesterol management accounted for some of the disparity in cholesterol control between women and men but not between black and white patients.

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Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Stephen D. Persell MD, MPH

  2. Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Saverio M. Maviglia MD, David W. Bates MD, MSc & John Z. Ayanian MD, MPP

  3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    John Z. Ayanian MD, MPP

Authors
  1. Stephen D. Persell MD, MPH
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  2. Saverio M. Maviglia MD
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  3. David W. Bates MD, MSc
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  4. John Z. Ayanian MD, MPP
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Corresponding author

Correspondence to Stephen D. Persell MD, MPH.

Additional information

Dr. Bates is a consultant and serves on the advisory board for McKesson MedManagement, a company that assists hospitals in preventing adverse drug events. He is on the clinical advisory board for Voltage Inc., which compiles information on compliance for drug companies.

This work was supported in part by institutional National Research Service Award 5T32HS00020-16 (Dr. Persell) and grant RO1 #1 U18 HS11046 from the Agency for Healthcare Research and Quality, Rockville, MD.

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Persell, S.D., Maviglia, S.M., Bates, D.W. et al. Ambulatory hypercholesterolemia management in patients with atherosclerosis. J GEN INTERN MED 20, 123–130 (2005). https://doi.org/10.1111/j.1525-1497.2005.40155.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40155.x

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