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John Z. Ayanian, MD, MPP; Mary Beth Landrum, PhD; Barbara J. McNeil, MD, PhD

Arch Intern Med. 2002;162:1013-1019.

Background  Use of cholesterol-lowering drugs reduces mortality and adverse cardiac events among people aged 65 to 75 years with coronary heart disease, but previous studies have shown that most patients have not received this treatment.

Methods  We conducted a telephone survey during 1999 and 2000 of 815 Medicare beneficiaries aged 65 to 74 years hospitalized for an acute myocardial infarction in California, Florida, Massachusetts, New York, or Pennsylvania during 1994 and 1995. Outcome measures included use of cholesterol-lowering drugs, beliefs about the importance of lowering cholesterol levels, and knowledge of personal cholesterol levels, adjusting for demographic and clinical factors using logistic regression.

Results  Among respondents, 59.4% reported taking a cholesterol-lowering drug, but most were not aware of potential adverse effects. In adjusted analyses, drug treatment was significantly more common among women, patients aged 65 to 69 years, and those who reported that a cardiologist was mainly responsible for their cholesterol management. Lowering cholesterol levels was viewed as "very important" by 77.2% of respondents, but significantly less often by men, older patients, and those with diabetes mellitus or congestive heart failure. Only 33.1% of respondents knew their cholesterol level, and this knowledge was significantly less common among black patients and those with diabetes mellitus or congestive heart failure.

Conclusions  Use of cholesterol-lowering drugs was much greater than in previous studies of elderly patients after myocardial infarction, demonstrating increased attention to secondary prevention. However, most patients were unaware of their cholesterol level or potential adverse effects of drug treatment, indicating that they may benefit from greater education about cholesterol testing and treatment.

From the Division of General Medicine and Primary Care, Department of Medicine (Dr Ayanian), and the Department of Radiology (Dr McNeil), Brigham and Women's Hospital and Harvard Medical School, and the Department of Health Care Policy, Harvard Medical School (Drs Ayanian, Landrum, and McNeil), Boston, Mass.

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