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. 2015 May;48(5):520-7.
doi: 10.1016/j.amepre.2014.10.025.

Race-sex differences in the management of hyperlipidemia: the REasons for Geographic and Racial Differences in Stroke study

Monika M Safford  1 , Christopher M Gamboa  2 , Raegan W Durant  3 , Todd M Brown  3 , Stephen P Glasser  3 , James M Shikany  3 , Richard M Zweifler  4 , George Howard  5 , Paul Muntner  2
Affiliations

Race-sex differences in the management of hyperlipidemia: the REasons for Geographic and Racial Differences in Stroke study

Monika M Safford et al. Am J Prev Med. 2015 May.

Abstract

Background: Lipid management is less aggressive in blacks than whites and women than men.

Purpose: To examine whether differences in lipid management for race-sex groups compared to white men are due to factors influencing health services utilization or physician prescribing patterns.

Methods: Because coronary heart disease (CHD) risk influences physician prescribing, Adult Treatment Panel III CHD risk categories were constructed using baseline data from REasons for Geographic And Racial Differences in Stroke study participants (recruited 2003-2007). Prevalence, awareness, treatment, and control of hyperlipidemia were examined for race-sex groups across CHD risk categories. Multivariable models conducted in 2013 estimated prevalence ratios adjusted for predisposing, enabling, and need factors influencing health services utilization.

Results: The analytic sample included 7,809 WM; 7,712 white women; 4,096 black men; and 6,594 black women. Except in the lowest risk group, black men were less aware of hyperlipidemia than others. A higher percentage of white men in the highest risk group was treated (83.2%) and controlled (72.8%) than others (treatment, 68.6%-72.1%; control, 52.2%-65.5%), with black women treated and controlled the least. These differences remained significant after adjustment for predisposing, enabling, and need factors. Stratified analyses demonstrated that treatment and control were lower for other race-sex groups relative to white men only in the highest risk category.

Conclusions: Hyperlipidemia was more aggressively treated and controlled among white men compared with white women, black men, and especially black women among those at highest risk for CHD. These differences were not attributable to factors influencing health services utilization.

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Figures

Figure 1
Figure 1
Prevalence, awareness, treatment and control of hyperlipidemia, by race-sex group and coronary heart disease risk category Note: Asterisks indicate statistically significant differences compared with white men in the same category of risk. No black women achieved control in the FRS>20% category. CVD, cardiovascular disease; FRS, Framingham coronary heart disease risk score
Figure 2
Figure 2
Prevalence ratios and 95% CIs for each race-sex group relative to white men, stratified by ATP III risk group Note: Prevalence ratios from models fully adjusted for factors influencing health services utilization. ATP, Adult Treatment Panel; CVD, cardiovascular disease; FRS, Framingham coronary heart disease risk score
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