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Time Trends in the Use of Cholesterol-Lowering Agents in Older Adults
The Cardiovascular Health Study
Rozenn N. Lemaitre, PhD, MPH;
Curt D. Furberg, MD, PhD;
Anne B. Newman, MD, MPH;
Stephen B. Hulley, MD, MPH;
David J. Gordon, MD, PhD;
John S. Gottdiener, MD;
Robert H. McDonald, Jr, MD;
Bruce M. Psaty, MD, PhD
Arch Intern Med. 1998;158:1761-1768.
Objectives To describe recent temporal patterns of cholesterol-lowering medication use and the characteristics that may have influenced the initiation of cholesterol-lowering therapy among those aged 65 years or older.
Subjects and Methods A cohort of 5201 adults 65 years or older were examined annually between June 1989 and May 1996. We added 687 African American adults to the cohort in 1992-1993. We measured blood lipid levels at baseline and for the original cohort in the third year of follow-up. We assessed the use of cholesterol-lowering drugs at each visit.
Results The prevalence of cholesterol-lowering drug use in 1989-1990 was 4.5% among the men and 5.9% among the women; these figures increased over the next 6 years to 8.1% and 10.0%, respectively, in 1995-1996. There was a 4-fold increase in the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors during the 6 years of follow-up, from 1.9% of all participants in 1989-1990 to 7.5% in 1995-1996. The use of bile acid sequestrants, nicotinic acid, and probucol declined from initial levels of less than 1% each. Among the participants who were untreated in 1989-1990, but eligible for cholesterol-lowering therapy after a trial of dietary therapy according to the 1993 guidelines of the National Cholesterol Education Panel, less than 20% initiated drug therapy in the 6 years of follow-up, even among subjects with a history of coronary heart disease. Among participants untreated at baseline but eligible for either cholesterol-lowering therapy or dietary therapy, initiation of cholesterol-lowering drug therapy was directly associated with total cholesterol levels, hypertension, and a history of coronary heart disease, and was inversely related to age, high-density lipoprotein cholesterol levels, and difficulties with activities of daily living. Other characteristics that form the basis of the 1993 National Cholesterol Education Panel guidelines—diabetes, smoking, family history of premature coronary heart disease, and total number of risk factors—were not associated with the initiation of cholesterol-lowering drug therapy.
Conclusions Given the clinical trial evidence for benefit, those aged 65 to 75 years and with prior coronary heart disease appeared undertreated with cholesterol-lowering drug therapy.
From the Cardiovascular Health Research Unit, the Departments of Medicine (Drs Lemaitre and Psaty), Epidemiology (Dr Psaty), and Health Services (Dr Psaty), University of Washington, Seattle; Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC (Dr. Furberg); Departments of Medicine (Dr Newman) and Epidemiology (Drs Newman and McDonald), University of Pittsburgh, Pittsburgh, Pa; Department of Epidemiology and Biostatistics, University of California at San Francisco (Dr Hulley); Division of Heart and Vasular Diseases, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Gordon); and the Division of Cardiology, Georgetown University Hosipital, Washington DC (Dr Gottdiener)
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