ADHERENCE TO NATIONAL CHOLESTEROL EDUCATION-PROGRAM TREATMENT GOALS IN POSTMENOPAUSAL WOMEN WITH HEART-DISEASE - THE HEART AND ESTROGEN PROGESTIN REPLACEMENT STUDY (HERS)/

Objectives.-To determine the proportion of volunteer women with establ ished heart disease who have low-density lipoprotein cholesterol (LDL- C) levels at or below the National Cholesterol Education Program Adult Treatment Panel goals and to determine what factors are associated wi th levels above goal or not receiving lipid-lowering medication when i ndicated. Design.-Cross-sectional measurement of lipids and lipoprotei ns, blood pressure, height, weight, and other demographic and cardiova scular risk factors in 2763 postmenopausal women with heart disease. S etting.-At 18 centers throughout the United States, participants were recruited by means of lists of women with coronary heart disease from coronary units and catheterization laboratories, direct mail to age-el igible women, and advertisements. Patients.-Mean age of the cohort was 66.7 years (range, 44-79 years) and the distribution by race/ethnicit y was 88.7% white, 7.9% African American, 2.0% Hispanic/Latina, 0.8% A sian/Pacific Islander, and 0.7% other. Intervention.-We report cross-s ectional analysis of the cohort at baseline. Outcome Measures.-We meas ured the frequency of achieving 1988 and 1993 Adult Treatment Panel tr eatment goals, and of being on a regimen of lipid-lowering medication. Results.-Although 47% of participants were taking a lipid-lowering me dication, 63% did not meet the 1988 treatment goal of LDL-C level less than 3.4 mmol/L (130 mg/dL) and 91% did not meet the 1993 goal of LDL -C level less than 2.6 mmol/L (100 mg/dL). Factors independently assoc iated with achieving the earlier goal were use of lipid-lowering medic ation, marital status, education, body mass index, exercise, hypertens ion, diabetes, gallbladder disease, and first diagnosis of coronary he art disease after 1990. Failure to use lipid-lowering medication was a ssociated with age, being African American, marital status, body mass index, lack of exercise, alcohol consumption, current smoking, and fir st diagnosis of coronary heart disease before 1985. Conclusion.-The ma jority of women enrolled in the trial had LDL-C levels that significan tly exceeded the treatment goals set by the 1988 and 1993 Adult Treatm ent Panel guidelines. Better implementation of these guidelines among women with coronary disease would be highly desirable.