A Retrospective Cohort Study of the Potency of lipid-lowering therapy and Race-gender Differences in LDL cholesterol control

BMC Cardiovascular Disorders

Simon SK Tang¹  Mark Weiner³  Christopher S Hollenbeak²  Barbara J Turner³ 

[1] Pfizer, Inc., 235 East 42nd Street, New York, NY, 10017, USA;Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Drive, A210, Hershey, PA, 17033, USA;Division of General Internal Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA

关键词: survival analysis;    healthcare disparities;    anticholesterolemic agents;    dyslipidemia;   

Others  :  1085667
DOI  :  10.1186/1471-2261-11-58

 received in 2010-11-02, accepted in 2011-09-30,  发布年份 2011

【 摘 要 】

Background

Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.

Methods

We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.

Results

Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.

Conclusions

Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.

【 授权许可】

   
2011 Turner et al; licensee BioMed Central Ltd.

【 图 表 】

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