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Sex Bias and Underutilization of Lipid-Lowering Therapy in Patients With Coronary Artery Disease at Academic Medical Centers in the United States and Canada
Michael Miller, MD;
Robert Byington, PhD;
Donald Hunninghake, MD;
Bertram Pitt, MD;
Curt D. Furberg, MD, PhD;
for the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) Investigators
Arch Intern Med. 2000;160:343-347.
Background The efficacy of lipid-lowering therapy (LLT) has been well established for patients with preexisting coronary artery disease (CAD). However, limited information is available assessing the extent to which these medications are prescribed in academic medical centers.
Methods The use of LLT for patients with CAD was prospectively evaluated in 825 men and women who were recruited from 16 academic medical centers in the United States and Canada to participate in the Prospective Evaluation of the Vascular Events of Norvasc Trial (PREVENT). The assessment of LLT use during the 3-year trial was evaluated in patients receiving amlodipine therapy and placebo; levels of low-density lipoprotein cholesterol (LDL-C) were used to assess the impact of LLT.
Results Despite a baseline prevalence of LLT in 42% of men (38% in 1994), half of the patients had high levels of LDL-C (>3.36 mmol [>130 mg/dL]). During the subsequent 3 years, the prevalence of elevated LDL-C levels dropped in men (29%) but remained stagnant in women (48%). These changes were associated with increased LLT in men (55%) but not in women (35%) (P = .04). In 1994, the LDL-C target goal (<2.59 mmol/L [<100 mg/dL]) was attained in 17% of men and 6% of women (P = .006). At study completion in 1997, the LDL-C target goal was achieved in 31% of men and only 12% of women (P = .001).
Conclusions This study highlights the relatively low treatment rates of hyperlipidemia among patients with CAD overall and women in particular who were participating in a clinical trial at academic medical centers in the United States and Canada. Because LLT has been proven to reduce future cardiovascular events, these results suggest that more intensive efforts should be promoted in order to maximize CAD reduction.
From the Department of Medicine, University of Maryland Medical Center, Baltimore (Dr Miller); the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Byington and Furberg); the Department of Medicine, University of Minnesota School of Medicine, Minneapolis (Dr Hunninghake); and the Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (Dr Pitt).
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