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Trends in Lipid Management Among Patients With Coronary Artery Disease

Has diabetes received the attention it deserves?

¹ Medical Review of North Carolina, Cary, North Carolina
² School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
³ Outcomes Research and Management, Merck & Company, West Point, Pennsylvania
⁴ School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

OBJECTIVE—To examine lipid management trends for coronary artery disease (CAD) patients with and without diabetes in order to determine whether those with diabetes are beginning to receive aggressive lipid management consistent with their elevated risk.

RESEARCH DESIGN AND METHODS—We used outpatient medical record data from 47,813 CAD patients seen at 295 medical practices participating in the Quality Assurance Program II between 1996 and 1998. Lipid testing rates, lipid treatment rates, and serum lipid concentrations are described for CAD patients with and without diabetes within strata of office visit date.

RESULTS—Lipid testing and treatment rates increased and mean lipid levels decreased markedly over time. Those with diabetes were 26% less likely to have a lipid profile and 17% less likely to receive a lipid-lowering medication than their nondiabetic counterparts, and this disparity did not diminish over time. Among treated patients, mean non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C) declined less rapidly over time for patients with than without diabetes.

CONCLUSIONS—Although impressive progress was made in the outpatient lipid management of CAD patients, lipid management for CAD patients with diabetes improved no more rapidly, and in some cases less rapidly, than for nondiabetic patients. Given their higher risk, more effort is needed to ensure that CAD patients with diabetes receive aggressive lipid management.

Abbreviations: ADA, American Diabetes Association • CAD, coronary artery disease • LDL-C, LDL cholesterol • MI, myocardial infarction • NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III • NDEP, National Diabetes Education Program • non-HDL-C, non-HDL cholesterol • QAP, Quality Assurance Program.

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