Despite evidence that cholesterol-lowering medications can reduce the risk of heart attacks and death in people with coronary artery disease, many physicians at major teaching hospitals in the U.S. and Canada still do not prescribe them, according to a new study. The study, published in the February 14 issue of the Archives of Internal Medicine, also shows that significantly fewer women than men with heart disease are receiving any medication at all.
"In general, treatment rates for patients with a history of heart disease were far too low, but the lack of adequate treatment in women was particularly worrisome," says Michael Miller, M.D., director of Preventive Cardiology at the University of Maryland Medical Center and associate professor of Medicine at the University of Maryland School of Medicine. Dr. Miller is the lead author of the study.
The study focuses on the use of cholesterol lowering medications in 825 men and women with coronary artery disease at 16 academic medical centers in the United States and Canada. About half of the participants had dangerously high levels of LDL, the "bad" form of cholesterol, above 130 mg/dl. Twenty percent of those in the study were women.
The researchers looked at the percentage of patients with high LDL levels who were offered cholesterol-lowering drugs from 1994 to 1997, and found that while the numbers improved slightly for men, treatment for women lagged far behind. In 1994, 38 percent of women and 42 percent of men with elevated LDL were receiving cholesterol-lowering medication. By 1997, the percentage of men on medication had increased to 54 percent while the percentage among women dropped to 35 percent.
In addition to under-treatment for high cholesterol levels, the investigators also looked at the percentage of patients achieving the LDL goal of 100 mg/dl. By the end of the study, 31 percent of men had lowered their LDL to the acceptable level, while only 12 percent of women reached LDL levels below 100 mg/dl.
"We don't know why women were so under-treated compared to men, especially since the extent of heart disease was similar in both groups," says Dr. Miller.
"These results provide evidence of considerable sex bias in the treatment of women with heart disease at major academic medical centers. Heightened awareness of this discrepancy should prompt physicians to more carefully identify women who may benefit from cholesterol lowering medication," adds Dr. Miller.
Heart disease is the number-one killer of both men and women. Recent studies have demonstrated that heart attack rates can be reduced in both sexes with cholesterol-lowering medications known as statins. These include Zocor (simvastatin) and Pravachol (pravastatin).
According to the National Cholesterol Education Program guidelines, the LDL goal in heart disease patients should be below 100 mg/dl. The guidelines also say that people should be treated with cholesterol-lowering medications if, after making changes in their diet, their LDL exceeds 130 mg/dl.
Other authors of the study include Drs. Robert Byington and Curt Furberg at Wake Forest University School of Medicine, Dr. Don Hunninghake at the University of Minnesota School of Medicine and Dr. Bert Pitt at the University of Michigan Medical Center.
The study was funded by Pfizer Pharmaceuticals. The Archives of Internal Medicine has the highest readership of all the subspecialty journals published by the American Medical Association.
(To find out more about the University of Maryland Heart Center, go to umm.edu/mdheart).
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