UNDERUTILIZATION OF MEASUREMENT OF SERUM LOW-DENSITY-LIPOPROTEIN CHOLESTEROL LEVELS AND OF LIPID-LOWERING THERAPY IN OLDER PATIENTS WITH MANIFEST ATHEROSCLEROTIC DISEASE

OBJECTIVE: To investigate the prevalence of measurement of serum lipid s and of utilizing lipid-lowering therapy, when appropriate, in older persons without contraindications to lipid-lowering drugs and with myo cardial infarction (MI), stroke, peripheral arterial disease (PAD), an d no coronary artery disease (CAD), stroke, or PAD. DESIGN: A retrospe ctive analysis of charts of all older patients seen from January 1, 19 97, through October 15, 1997, was performed to investigate the prevale nce of measurement of serum lipids and utilization of lipid-lowering t herapy, when appropriate, in older persons without contraindications t o lipid-lowering drugs and with MI, stroke, PAD, and no CAD, stroke, o r PAD. Patients with life-limiting comorbidities were not included in the study. SETTING: An academic, hospital-based geriatrics practice st affed by fellows in a geriatrics training program and full-time facult y geriatricians. PARTICIPANTS: A total of 373 men and 1119 women, mean age 80 +/- 8 years (range 59 to 103 years), were included in the stud y. MEASUREMENTS AND MAIN RESULTS: Serum low-density lipoprotein (LDL) cholesterol was measured in 201 of 391 patients (51%) with MI, in 78 o f 187 patients (42%) with stroke, in 58 of 115 patients (50%) with PAD , and in 396 of 926 patients (43%) with no CAD, stroke, or PAD. In pat ients with elevated serum LDL cholesterol levels, lipid-lowering drug therapy was given to eight of 15 patients (53%) <70 years of age with MI, to 34 of 63 patients (54%) 70 to 80 years of age with MI, and to 3 8 of 81 patients (47%) > 80 years of age with MI (P not significant); to three of seven patients (43%) <70 years of age with stroke, to 12 o f 26 patients (46%) 70 to 80 years of age with stroke, and to 13 of 32 patients (41%) >80 years of age with stroke (P not significant); to t wo of four patients (50%) (70 years of age with PAD, to seven of 17 pa tients (41%) 70 to 80 years of age with PAD, and to 10 of 25 patients (40%) >80 years of age with PAD (P not significant); and to six of 15 patients (40%) <70 years of age with no CAD, stroke, or PAD, to 26 of 70 patients (37%) 70 to 80 years of age with no CAD, stroke or PAD, an d to 14 of 47 patients (30%) >80 years of age with no CAD, stroke, or PAD (P not significant). None of the other patients with MI, stroke, P AD, or no CAD, stroke, or PAD was treated with diet or lipid-lowering drugs. CONCLUSIONS: Measurement of serum LDL cholesterol and of approp riate use of lipid-lowering drugs and diet in older patients with MI, stroke, PAD, and no CAD, stroke, or PAD is underutilized in an academi c, hospital-based geriatrics practice.