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Insufficient treatment of hypercholesterolemia among patients hospitalized with chest pain
Eric E Howell1, Scott M Wright, David E Bush
1Department of Medicine, Johns Hopkins Medical Institutions, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Hospitalization for chest pain often fails to initiate lipid-lowering therapy, especially in women. This missed opportunity impacts cardiovascular disease management and patient health outcomes.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Coronary artery disease (CAD) significantly contributes to morbidity and mortality.
- Pharmacologic interventions can improve CAD outcomes, yet many patients remain undertreated.
- Hyperlipidemia is a key modifiable risk factor for CAD.
Purpose of the Study:
- To determine if hospitalization for suspected myocardial ischemia prompts the initiation of appropriate lipid-lowering therapy.
- To assess the rates of lipid-lowering treatment initiation in patients admitted with chest pain.
- To identify factors associated with receiving lipid-lowering therapy post-hospitalization.
Main Methods:
- Prospective, observational study of consecutive patients with active chest pain admitted to the Emergency Department.
- Inclusion criteria: elevated low-density lipoprotein (LDL) levels (>100 mg/dl with CAD history or >130 mg/dl without CAD history).
- Data collection at admission, discharge, and 4-month follow-up.
Main Results:
- Lipid-lowering therapy initiation increased from admission to discharge (men: 65% to 79%; women: 55% to 60%).
- Treatment rates remained similar at 4-month follow-up.
- Independent predictors for receiving therapy at discharge included age ≥65 years and male gender.
Conclusions:
- Hospitalization for chest pain is a critical juncture for initiating lipid-lowering therapy.
- Initiation of hyperlipidemia treatment is frequently missed, particularly in female patients.
- Addressing this gap in care presents a significant opportunity to improve cardiovascular health outcomes.
Background:
Although morbidity and mortality from coronary artery disease can be improved with a variety of pharmacologic interventions, many patients remain undertreated.
Hypothesis:
This study sought to assess whether hospitalization for possible coronary artery disease would prompt initiation of appropriate lipid-lowering therapy.
Methods:
This prospective, observational study was conducted on consecutive patients with active chest pain admitted to the Emergency Department of the hospital for suspected myocardial ischemia. Elevated cholesterol, defined as low-density lipoprotein (LDL), was >100 mg/dl with a prior history or a new diagnosis of coronary artery disease, or an LDL >130 mg/dl without known coronary artery disease. Data were recorded at the time of admission, discharge, and at 4-month follow-up.
Results:
Of the patients with hyperlipidemia, 65% men and 55% women were on medication at the time of admission (p = 0.30), while at discharge, 79% men and 60% women were on treatment (p = 0.002), with similar rates of treatment at 4-month follow-up (p = 0.030). At discharge, two variables were independently associated with patients receiving lipid-lowering therapy: age > or =65 years (odds ratio = 2.3; 95% confidence interval 1.2-4.5) and male gender (2.7; 15-5.0).
Conclusions:
In patients hospitalized with chest pain, particularly in women, the initiation of treatment of hyperlipidemia frequently does not happen. This oversight represents a lost opportunity for making an impact on the health of this population.
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