Factors Related to Treatment of Patients at High Risk for Cardiovascular Events with Cholesterol-lowering Medications

Background:

Numerous clinical trials have shown that cholesterol-lowering drugs improve the morbidity and mortality for patients at high risk for cardiovascular events.

Objective:

To identify the characteristics of patients who are at high risk for cardiovascular events but not on cholesterol-lowering medication.

Study Population:

This was a retrospective analysis of administrative data from a large health plan in Hawaii of patients at high risk for cardiovascular disease (n=23,167 unique patients). To qualify as high risk, a member would need to be: 1) 19 to 75 years of age with coronary artery disease; 2) 41 to 75 years of age with diabetes and hypertension or hyperlipidemia; 3) any age with both diabetes and cardiovascular disease.

Methodology:

Multivariable logistic regression analysis was used to estimate the relationship between patient characteristics (age, gender, morbidity level, region, type of health coverage, conditions) and receipt of cholesterol lowering medications.

Results:

Overall 74 percent of patients at high risk for cardiovascular disease were receiving cholesterol-lowering medications. The largest differences related to age and region. We found that the compared to patients aged 45 to 64, patients under age 30 [Odds ratio=0.18, 95%CI (0.62,0.50)], and patients aged 30 to 45 [OR=0.55 95%CI (0.47,0.65)] were significantly less likely to be on cholesterol-lowering medications. Compared to patients in Honolulu, patients living on the island of Hawaii on the east side [OR=0.62, 95%CI (0.56,0.68)] or the west side [OR=0.85, 95%CI (0.72,1.00)] were less likely to receive treatment. Other factors related to a reduced likelihood of medication use were being female [OR=0.86, 95%CI (0.81, .92)], having HMO [OR=0.91, 95%CI (0.83, 0.99)] or Medicare coverage [OR=0.72, 95%CI (0.64,0.82)] and having congestive heart failure [OR=0.82, 95%CI (0.73, 0.91)]. Factors related to increased likelihood of use were being age 65 to 79, living on Kauai, and having diabetes.

Conclusion:

Targeted interventions may be needed among patients who: 1) are under age 45; 2) live on the Big Island of Hawaii; 3) are female; 4) have congestive heart failure.