Overtreatment and Undertreatment of Hyperlipidemia in the Outpatient Setting
Southern Medical Journal,
Verma A et al. – Both overtreatment and under–treatment are common. Physicians’ decisions appear to reflect LDL values and number of risk factors rather than calculated cardiovascular risk.Methods
- The authors conducted a retrospective chart review of patients aged 35 to 80 years attending an inner–city ambulatory teaching clinic.
- The authors noted patients’ 10–year cardiovascular risk based on the Framingham Heart Study equation, other patient demographics, pretreatment lipid levels, and whether they received a prescription for lipid–lowering therapy.
- Of 676 patients included, 46% were at high (>15% for 10 years) and 37% were at low (<5%) risk.
- Of the patients at high risk for CHD, 34% received no drug therapy, including 5% of patients with known CHD; 37% of patients with diabetes mellitus; and 59% of patients without CHD equivalents.
- Undertreatment was associated with lower low–density lipoprotein (LDL; odds ratio [OR] per 30 mg/dL 2.7, confidence interval [CI] 2.0–3.6), fewer risk factors (OR per risk factor 1.5 CI 1.1–2.1), and not receiving other preventive care interventions (OR 2.1, CI 1.0–4.5). Of 247 patients at low risk for CHD, 8% received drug therapy.
- Overtreatment was associated with higher LDL (OR per 30 mg/dL 3.0, CI 1.7–5.3) and more cardiac risk factors (OR per risk factor 3.1, CI 1.4–6.7).
- Age, race, sex, and specific risk factors were not associated with overtreatment or undertreatment.