Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?
Authors: Gmerice Hammond, Heidi Mochari-Greenberger, Ming Liao, Lori Mosca
Journal: Circulation (2012)

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL&lt;100 mg/dL) and aggressive target (LDL&lt;70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL &lt;100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL&lt;70 [48% (688/1446) vs 36% (271/744); p&lt;0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL&lt;70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL&lt;100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL&lt;70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL &lt;70 and &lt;100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL &lt;70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.