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Use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction
Authors:Dr. John Z. Ayanian MD   MPP  Bruce E. Landon MD   MBA  Mary Beth Landrum PhD  James R. Grana PhD  Barbara J. McNeil MD   PhD
Affiliation:Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. ayanian@hcp.med.harvard.edu
Abstract:OBJECTIVE: To assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction. DESIGN: Telephone survey and administrative data. SETTING: National managed-care company. PARTICIPANTS: Six hundred ninety-six adults age 30 to 64 surveyed in 1999, approximately 1 to 2 years after a myocardial infarction. MEASUREMENTS: Use of cholesterol-lowering drugs, beliefs about the importance of lowering cholesterol, and knowledge of personal cholesterol level, adjusting for demographic and clinical factors with logistic regression. MAIN RESULTS: Among respondents, 62.5% reported they were taking a cholesterol-lowering drug. In adjusted analyses, these drugs were used significantly less often by African-American patients and those with congestive heart failure or peripheral vascular disease, and more often by college graduates, patients with hypertension, and those who had seen a cardiologist since their myocardial infarction. Lowering cholesterol was viewed as "very important"; by 87.1% of patients, but significantly less often by smokers and more often by those who had undergone coronary angioplasty or bypass surgery. Only 42.5% of respondents knew their cholesterol level, and this knowledge was significantly less common among less-educated or less-affluent patients, African-American patients, and patients who smoked or had diabetes or peripheral vascular disease. CONCLUSIONS: Although most patients recognized the importance of lowering cholesterol after myocardial infarction, several clinical and demographic subgroups were less likely to receive cholesterol-lowering therapy, and many patients were unaware of their cholesterol level. Health-care providers and managed-care plans can use these findings to promote cholesterol testing and treatment for patients with coronary heart disease who are most likely to benefit from these efforts.
Keywords:myocardial infarction    coronary disease    hypercholesterolemia    hyperlipidemia    drug therapy    anticholesteremic agents    attitude toward health    knowledge, attitudes, practices    middle age
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