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Monika Safford, MD; Laura Eaton, MD; Gerald Hawley, RN; Michael Brimacombe, PhD; Mangala Rajan, MBA; Huiling Li, PhD; Leonard Pogach, MD, MBA

Arch Intern Med. 2003;163:922-928.

Background  People with diabetes are at high risk for cardiovascular events regardless of known heart disease. Physicians may underrecognize the excess cardiovascular risk conferred by diabetes alone, without a recent cardiovascular event. Other disparities in the receipt of lipid-lowering medications (LLMs) may exist.

Methods  We studied veterans with diabetes in fiscal years 1998 and 1999 cross-sectionally. We used administrative data (demographic information, International Classification of Diseases, Ninth Revision [ICD-9] codes, utilization information, medications, and laboratory tests) to evaluate associations between use of LLMs and age, ethnicity, sex, marital status, Charlson Index, heart disease ICD-9 codes, oral agents and insulin, hospitalization status, and low-density lipoprotein cholesterol levels. We constructed separate logistic regression models to evaluate associations between low-density lipoprotein cholesterol and similar predictor variables.

Results  Odds ratios were similar in both years. For fiscal year 1999, patients without recent ICD-9 codes in their administrative data indicating heart disease were 0.35 times less likely to be given LLMs than those with such codes. Individuals older than 75 years were 0.65 times less likely to be given LLMs than those younger than 65 years. African Americans were 0.72 times less likely than whites to be given LLMs. In fiscal years 1999 and 1998, 27% and 36% of individuals given LLMs had low-density lipoprotein cholesterol levels higher than 130 mg/dL (3.37 mmol/L).

Conclusions  Veterans with diabetes but no recently coded heart disease, older individuals, and African Americans could benefit from programs targeted to introduce LLMs. Up to one third of individuals given LLMs remained above the target level of 130 mg/dL for low-density lipoprotein cholesterol.

From the New Jersey Veterans Health Administration Healthcare System, East Orange, NJ (Drs Safford, Brimacombe, and Pogach and Ms Rajan); Departments of Medicine (Drs Eaton and Pogach) and Preventive Medicine (Dr Brimacombe), University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark; Veterans Health Administration Healthcare Analysis Information Group, Milwaukee, Wis (Mr Hawley); and Department of Statistics, Columbia University, New York, NY (Dr Li). The authors have no relevant financial interest in this article.

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