Major CHD risk factors predominate among African-American women who are eligible for lipid-lowering drug therapy under the new ATP III guidelines

Abstract

Background

Coronary heart disease remains the leading cause of morbidity and death among African-Americans. We studied the cardiovascular risk factor distributions among African-American men and women deemed eligible for lipid-lowering treatment under the new Adult Treatment Panel Guidelines (ATPIII).

Design and methods

A sub-sample of African-American NHANES III subjects aged 20-79 years, with known cardiovascular risk factors and LDL-C levels was identified (n = 4,213). We assessed their eligibility for drug therapy using the new ATP III criteria and compared CHD risk factor distributions across gender. Both conservative and drug-optional LDL-C target levels were applied.

Results

An estimated 5.7 million African-Americans aged 20-79 are eligible for drug therapy under ATP III, and the overall eligibility prevalence is 24.3%; 47.8% are males and 52.2% are females (P< 0.001). Of these, 1.87 million are eligible based on drug-optional LDL-C targets and 54.5% of these are female. Of treatment-eligible individuals, 61% of males versus 72% of females exhibited LDL-C ≥ 160mg/dl (P= 0.0001). The prevalence and levels of important CHD risk factors such as diabetes, hypertension, mean total and LDL-C cholesterol levels, and body mass index were all greater for eligible females compared to males despite lower absolute Framingham risk estimates for females.

Conclusions

Among African-Americans, more women than men are eligible for treatment under the new ATP III guidelines. Eligibility in women is based primarily on diabetes and lipid levels rather than absolute Framingham risk, which seems to be underestimated in African-American women. As compensation for this underestimate, drug-optional (lower) targets should be applied to this population.