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Health Care Disparities

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Women and men with cardiovascular disease may not receive the same level of treatment for high cholesterol

Despite the fact that cardiovascular disease (CVD) is the leading cause of death among women, they are less aggressively screened and treated for cholesterol problems than men, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11540). Following a review of studies on the topic, Timothy P. Hofer, M.D., M.S., of the University of Michigan and the VA Ann Arbor Healthcare System, and his colleagues conclude that women with CVD have suboptimal cholesterol management.

The majority of studies that examined screening and treatment for dyslipidemia characterized by high levels of low-density lipoprotein cholesterol (LDL-C, so-called "bad" cholesterol), low levels of high-density lipoprotein cholesterol (HDL-C, so-called "good" cholesterol), and elevated triglycerides, did not report analyses by sex or the degree of disparity between men and women. However, the studies that examined people with CVD indicated that men have cholesterol measured more often, are treated more aggressively (for example, with statin drugs), and have lower levels of LDL-C than women.

The reasons underlying these differences and poor management of dyslipidemia overall are not well understood, and it is unclear how to reduce the disparities between men and women. Yet these disparities may translate to significantly higher rates of CVD events (for example, heart attack and stroke) and mortality for women, caution the investigators. They add that suboptimal management of dyslipidemia in women may occur through the same mechanisms that cause male-female disparities in referrals for CVD diagnostic and therapeutic procedures.

See "Review of evidence and explanations for suboptimal screening and treatment of dyslipidemia in women," by Catherine Kim, M.D., M.P.H., Dr. Hofer, and Eve A. Kerr, M.D., M.P.H., in the October 2003 Journal of General Internal Medicine 18, pp. 854-863.

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