Assessment of antihyperlipidemic therapy in US patients with coronary heart disease.

CONTEXT Knowledge of the trends and possible differences in the use of antihyperlipidemic medications in US patients with coronary heart disease (CHD) is vital in order to stimulate a positive change in the health of society. OBJECTIVE To assess, in the ambulatory setting, the frequency of antihyperlipidemic medication use in US patients with CHD. DESIGN Retrospective, national, cross-sectional study using data from the 2004 National Ambulatory Medical Care Survey (NAMCS). METHODS Ambulatory medical visits surveyed by the 2004 NAMCS associated with select ICD-9-CM CHD-related diagnoses were included. Use of antihyperlipidemic medications was captured by searching the database for drug names. Demographics assessed for association with antihyperlipidemic therapy included region of the country in which care was provided; patient age group, sex, ethnicity, and race; physician medical degree; and payment type. Statistical analyses used sample weights to determine national estimates. RESULTS A weighted national estimate of nearly 16 million ambulatory medical care visits was made in the United States in 2004 of patients with one of the selected CHD diagnoses. Use of any form of lipid-lowering therapy was associated with 40.4% of the CHD patients seeking ambulatory-based medical care in 2004. Non-Hispanic/Latino patients with CHD were more than 4.5 times more likely to be receiving lipid-lowering therapy (odds ratio [OR], 4.59; 95% CI, 1.28-16.37). Patients with CHD who had Medicare as their form of payment for healthcare were less likely to be receiving lipid-lowering therapy (OR, 0.50; 95% CI, 0.28-0.91), as were those receiving medical care in the South region of the United States (OR, 0.36; 95% CI, 0.14-0.89). Similar differences in medication use were noted with the statin medication class. CONCLUSION In 2004, less than half of the ambulatory medical visits by US patients with CHD were associated with antihyperlipidemic treatment, and most of these patients were treated with one medication (a statin). A CHD patient's reported ethnicity, primary method of payment, and area of the United States in which care was received all demonstrated differences. On the basis of the growing evidence-based medical literature, it is imperative to continue this research to assess changes in future trends and to work with healthcare and policy advocates to strike a positive change for all patients.