Nearly half of
people who need cholesterol treatment don’t get it
Newswise — Even though
treatment for cholesterol disorders can reduce the risk
of heart and blood vessel disease by about 30 percent
over five years, many at-risk people aren’t getting
adequate treatment, according to researchers from Wake
Forest University School of Medicine and colleagues
reporting in Circulation: Journal of the American Heart
Association.
“Under-treatment of
cholesterol disorders is a major public health
challenge,” said lead author David Goff Jr., M.D., Ph.D.
“In our study of middle-age and older adults with no
symptoms of cardiovascular disease, about a third had
cholesterol disorders that would require drug treatment
under current guidelines. Yet, only 54 percent of those
who needed treatment were getting it.”
In addition, the
researchers found that cholesterol control was lowest in
study participants who were at the highest risk of
developing heart vessel disease. Cholesterol disorders –
such as having “good” cholesterol that is too low or
“bad” cholesterol that is too high – are a major risk
factor for cardiovascular disease, which is the leading
cause of death in the United States.
“Cardiovascular
disease is a significant health problem in this country
and lipid-lowering therapy has been proven to help
prevent it,” said Goff, a professor of public health
sciences and internal medicine at Wake Forest’s School
of Medicine, part of Wake Forest University Baptist
Medical Center. “Our research illustrates the importance
of improving the treatment and control of cholesterol
disorders and eliminating treatment disparities.”
The data came from the
Multi-Ethnic Study of Atherosclerosis (MESA), a
population-based study of 6,814 men and women who had no
known cardiovascular disease. Caucasian, Hispanic,
Chinese and African-American participant were recruited
some six communities (Forsyth County, Baltimore,
Chicago, Los Angeles, northern Manhattan, N.Y., and St.
Paul, Minn.).
The study’s main
objective is to determine the characteristics of early
cardiovascular disease – before symptoms develop – and
how it progresses. The goal of the current analysis was
to learn more about the challenge of implementing
cholesterol treatment guidelines issued by the National
Cholesterol Education Program.
For the study,
researchers measured participants’ blood pressure,
height, weight and cholesterol and asked them about
family history of heart attack, current smoking, and
current prescription drugs. Each participant’s 10-year
risk of developing disease of the coronary arteries was
calculated, and they were classified as being low risk,
moderate risk or high risk.
“We found that
cholesterol disorders were common in this population
that is free of known cardiovascular disease,” said
Goff. “And we found that cholesterol treatment and
control is far from optimal. The high-risk group had the
lowest level of control and there was evidence of gender
and ethnic disparities in both treatment and control.”
Among participants
with cholesterol disorders, men were 20 percent less
likely than women to be treated. Blacks and Hispanics
were less likely (15 percent and 20 percent,
respectively) than whites to be treated. The researchers
believe that the gender and ethnic disparities may be
related both to access to care and the tendency to seek
health care.
Women are more likely
than men to have health insurance and are reported to
seek health care services more often than men, the
researchers said. Blacks and Hispanics also have lower
health insurance coverage rates and poorer access to
care.
“Our study showed that
more research and quality improvement programs are
needed to optimize management of cholesterol disorders,”
Goff said.
The study was funded
by the National Heart, Lung and Blood Institute.
Co-researchers were Alain Bertoni, M.D., M.P.H., and
Denise Bonds, M.D., M.P.H., from Wake Forest, Holly
Kramer, M.D., M.P.H., from Loyola Medical Center, Roger
Blumenthal, M.D., from Johns Hopkins University School
of Medicine, Michael Y. Tsai, Ph.D., from the University
of Minnesota, and Bruce Psaty, M.D., Ph.D., M.P.H., from
the University of Washington.
Wake Forest University
Baptist Medical Center is an academic health system
comprised of North Carolina Baptist Hospital and Wake
Forest University Health Sciences, which operates the
university’s School of Medicine. The system comprises
1,187 acute care, psychiatric, rehabilitation and
long-term care beds and is consistently ranked as one of
“America’s Best Hospitals” by U.S. News & World Report.