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Women with atherosclerosis and high cholesterol receive less intense cholesterol management than men
Women with atherosclerosis (arteries clogged with plaque) receive less intense management of their cholesterol than men, but management of black and white patients with the condition is similar, according to a new study supported in part by the Agency for Healthcare Research and Quality (T32 HS00020). Researchers led by Stephen D. Persell, M.D., M.P.H., of Northwestern University, retrospectively examined the cholesterol management of 243 patients of primary care practices affiliated with the same academic medical center. The patients had coronary heart disease, cerebrovascular disease, or peripheral vascular disease and high low-density lipoprotein cholesterol (LDL-C) (over 130 mg/dl).
Cholesterol management by either medication intensification or LDL-C monitoring occurred at 31.2 percent of women's and 38.5 percent of men's visits, and 37.3 percent of black and 31.7 percent of white patients' visits. After adjusting for other factors, women were 23 percent less likely than men to have their cholesterol managed. Patients who saw a provider at their primary care site other than their primary care physician or those having a new clinical problem addressed were 77 percent and 40 percent, respectively, less likely to have their cholesterol managed.
Despite many visits, LDL-C levels below 130 mg/dl occurred less often for women than men (41 percent vs. 61 percent, respectively) 1 year after the initial visit. Also, at 12 months, black patients were less likely than white patients to achieve target LDL-C levels (39 percent vs. 58 percent, respectively), as were patients with Medicare only compared with those who had private insurance (37 percent vs. 58 percent, respectively).
Less intense cholesterol management accounted for some of the disparity in cholesterol control between women and men, but not between black and white patients. Lack of prescription drug coverage may have contributed to less cholesterol control among blacks and those with only Medicare insurance, suggest the researchers.
More details are in "Ambulatory hypercholesterolemia management in patients with atherosclerosis," by Dr. Persell, Saverio M. Maviglia, M.D., David W. Bates, M.D., M.Sc., and John Z. Ayanian, M.D., M.P.P., in the Journal of General Internal Medicine 20, pp. 123-130, February 2005.
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