More than a third of American adults are eligible to take cholesterol-lowering medications under the current guidelines– but nearly half of them are not, according to a report by the CDC. Blacks and Mexican Americans are less likely than whites to be taking cholesterol-lowering medications. A high blood level of low-density lipoprotein cholesterol (LDL-C) remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD).
Data from 2007 through 2014 show a decline in the number of Americans with high blood levels of cholesterol. There also has been a recent increase in the use of cholesterol-lowering medications. Because the 2013 guidelines focus on initiation or continuation of cholesterol treatment, adults meeting the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines' eligibility criteria as well as adults who were currently taking cholesterol-lowering medication were assessed as a group.
Some people with high LDL cholesterol and who are at risk of heart disease are eligible for cholesterol-lowering medications. They should also make lifestyle changes such as getting regular exercise, eating a heart-healthy diet, and losing weight. Yet fewer than half of people eligible for or who were taking cholesterol-lowering medication make these changes, the study found.
“Nearly 800,000 people die in the U.S. each year from cardiovascular diseases – that’s one in every three deaths – and high cholesterol continues to be a major risk factor,” said Dr. Carla Mercado, a scientist in the CDC’s Division for Heart Disease and Stroke Prevention. “This study reveals opportunities to reduce existing disparities through targeted patient education and cholesterol management programs.”
Getting 65 percent of Americans to manage their high levels of LDL cholesterol by 2017 is one of the major targets of the U.S. Department of Health and Human Services’ Million Hearts initiative to prevent one million heart attacks and strokes.
The ACC/AHA recommend cholesterol-lowering medication for four groups of adults:
- People with heart disease, a prior heart attack or some types of stroke, or angina
- People with LDL cholesterol levels of 190 mg/dL or more
- People ages 40 to 75 with diabetes and LDL cholesterol levels of 70-189 mg/dL
- People ages 40-75 with LDL cholesterol levels of 70-189 mg/dL and an estimated 10-year risk of heart disease of 7.5 percent or more
The CDC researchers examined data from the 2005-2012 National Health and Nutrition Examination Surveys. Overall, 36.7 percent of U.S. adults -- 78.1 million people age 21 or older -- were eligible for cholesterol-lowering medication or already taking it. Within this group, 55.5 percent were currently taking cholesterol-lowering medication and 46.6 percent reported making lifestyle changes; 37.1 percent reported making lifestyle modifications and taking medication, and 35.5 percent reported doing neither.
In alignment with incentives offered to health providers in the use of electronic medical records to improve patient care and to promote equitable and high-quality care, clinicians and public health practitioners can use sociodemographic data within their electronic health records to characterize the populations within their practices who are eligible for cholesterol treatment and implement targeted screening, patient education, and disease management programs. In addition, the 2013 ACC/AHA guidelines propose that clinicians monitor therapeutic response to cholesterol-lowering medications and reinforce adherence to both lifestyle regimens and medication at regular intervals.
Gender, race, and ethnicity made a difference. Of 40.8 percent of men eligible for or already on medication, 52.9 percent were taking medications. Of 32.9 percent of women eligible for or already on medication, 58.6 percent were taking medications. Of 24.2 percent of Mexican-Americans eligible for or already on medication, 47.1 percent were taking medications. Of 39.5 percent of blacks eligible for or already on medication, 46 percent were taking medications. Of 38.4 percent of whites eligible for or already on medication, 58 percent were taking medications. Blacks who did not have a routine place for health care had the lowest rate (5.7 percent) of taking recommended cholesterol-lowering medication. People who said they already had adopted a heart-healthy lifestyle (about 80 percent) were the group most likely to be taking cholesterol-lowering medication.
While the study included people taking all forms of cholesterol-lowering medication, nearly 90 percent of those receiving medication were taking a statin drug. Further efforts by clinicians and public health practitioners are needed to implement complementary and targeted patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol.
See the CDC Announcement
See the CDC Vital Signs Report
See also Medical Law Perspectives, February 2015 Report: Mending a Broken Heart: Malpractice Risks in Diagnosing and Treating Heart Disease
See also Medical Law Perspectives, February 2014 Report: Congenital Heart Conditions: How Infants, Adults, and Healthcare Providers Handle the Risks
See also Medical Law Perspectives, November 2013 Report: Diagnosis and Treatment of Heart Attacks: Liability Issues
See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication
See also Medical Law Perspectives, December 2013 Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death