196569 Factors Related to Treatment of Patients at High Risk for Cardiovascular Events with Cholesterol-lowering Medications

Sunday, November 8, 2009

Deborah Taira Juarez, ScD , Department of Public Health Studies, University of Hawaii; John A. Burns School of Medicine, Honolulu, HI

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


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.


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.


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.


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.

Learning Objectives:
Identify factors related to not receiving recommended cholesterol-lowering treatment among patients at high risk for cardiovascular events

Keywords: Cholesterol, Chronic (CVD)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a doctorate in health economics from the Harvard School of Public Health and have been conducting research in this area for 14 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.