CHICAGO — The gender gap in lipid management hasn't narrowed at all despite the March 2004 publication of American Heart Association evidence-based guidelines for prevention of cardiovascular disease in women, Dr. Lori Mosca reported at the annual scientific sessions of the AHA.
The percentage of high-risk women in two large southeastern health plans who attained an LDL cholesterol level below 100 mg/dL rose from 33% before release of the gender-specific guidelines to 40% afterward. At the same time, the proportion of high-risk men with an LDL cholesterol level below 100 mg/dL climbed from 41% to 50%. So the absolute difference in rates of good lipid control between men and women—the gender gap—actually increased from 8% prior to release of the AHA guidelines to 10% afterward, according to Dr. Mosca, director of preventive cardiology at New York-Presbyterian Hospital.
Clearly these data indicate lipid control remains suboptimal in both sexes, she added, since half of high-risk men and 60% of high-risk women had LDL cholesterol values in excess of the National Cholesterol Education Program (NCEP) target of 100 mg/dL.
The NCEP optional, more aggressive goal—an LDL level below 70 mg/dL—was achieved in 10% of men and 6% of women prior to the AHA gender-specific guidelines, and in 15% of men and 10% of women since then.
Dr. Mosca's retrospective study used administrative claims data for 17,070 men and 17,357 women. All patients were high risk due to cardiovascular disease or diabetes. The percentage who met NCEP lipid goals was assessed from September 2002 to February 2004 (before the guidelines were issued), and again from March 2004 to August 2005, after the guidelines came out.
Prior to the guidelines, 53% of these high-risk men and 44% of high-risk women were on LDL cholesterol-lowering drugs. Postguidelines, the proportions rose to 56% and 46%, respectively.
In an analysis controlling for age, metabolic syndrome, comorbidities, and other confounders, high-risk women were 32% less likely than men to attain an LDL cholesterol level below 100 mg/dL and 36% less likely to have a level below 70 mg/dL. But women were more likely to attain HDL cholesterol and triglyceride goals.