BALTIMORE — A study published recently in the Archives of Internal Medicine concluded that elevated lipid levels were not being treated often enough, especially in women. Researchers examined 825 men and women with coronary artery disease at 16 medical centers in the United States and Canada for three years. Although it has been established that lipid-lowering therapy is effective in patients with heart disease, the study found that only 31 percent of men and 12 percent of women achieved the targeted level for low-density lipoprotein, or "bad" cholesterol. InteliHealth spoke with Wendy Post, M.D., M.S., assistant professor of medicine at Johns Hopkins, who explained the significance of these findings.
InteliHealth: Do you agree with this research?
Dr. Post: Yes, I do.
IH: What exactly are lipids?
Dr. Post: Lipids are the fats that circulate in blood. Typically we measure them with what is called a fasting lipid profile, and that includes total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides levels. The current guidelines recommend that patients with coronary artery disease (CAD) be treated to get their LDL to less than 100 milligrams per deciliter so all of these patients who had CAD, if they didn't have an LDL less than 100 milligrams per deciliter, should be treated first with dietary therapy and, if that didn't work, then with medications. The most commonly used medications are the statins.
IH: What is the significance of these study results?
Dr. Post: I think there are two messages in this study: The first is that treatment is less commonly provided to women, and second, that treatment in general is suboptimal. Although the guidelines are clear, most patients are not achieving the recommended LDL cholesterol targets.
IH: Most patients in general or female patients?
Dr. Post: Most patients in general.
IH: Why not?
Dr. Post: It's probably a multifaceted reason. Cost may be an issue, and also the perceived side effects, although these medications really have very few side effects. Side effects are actually quite rare. But this study raised two issues: whether the patients were in therapy and whether that therapy was getting them to the target levels.
IH: Why is this is so important?
Dr. Post: The reason we recommend treatment is that there is clear evidence from large, randomized trials that people with CAD who are given statin medications have a 30 percent to 40 percent reduction in the likelihood of having a myocardial infarction, a heart attack. The issue this study brought to light is that women are less likely than men to be taking this therapy. I'm wondering if some of it has to do with the fact that cholesterol levels tend to rise after menopause, and maybe that's not being monitored in postmenopausal women. It's a topic that needs further research as to what the reasons are so that we can make sure that women get the treatment they need.
IH: How does this fit into the overall pattern of caring for women with heart disease?
Dr. Post: These are women who are documented to have CAD, but sometimes the disease itself is not recognized in women. The symptoms that are related to heart disease can be more subtle in women; women sometimes have atypical symptoms. We tend to think of heart disease as the typical chest pain that men have, and women can have that, too, but they also have atypical symptoms.
IH: What are those symptoms?
Dr. Post: Chest discomfort, especially if it's worse with exertion, shortness of breath, left arm pain, nausea, lightheadedness and jaw pain.
IH: Anything else you'd like to add?
Dr. Post: Similar data are available about blood pressure treatment. Even though there are clear goals for controlling high blood pressure, only about 27 percent of the people in the United States with high blood pressure have reached the proper levels. You could emphasize the differences in treatment between men and women, but in general it's important to emphasize that both men and women aren't reaching their goals for cholesterol and blood pressure treatments. But one positive thing that came to light from this study was that the likelihood of being on cholesterol medication increased as the study went on; the likelihood of someone being treated improved.
Copyright The Johns Hopkins University, 2000. All rights reserved. This interview is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
March 31, 2000
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