Women at the greatest risk for heart attack and death from heart disease along with dangerously high cholesterol levels are not receiving the benefits from lifesaving cholesterol drugs. "Cholesterol management in high-risk women has been proven to save lives and reduce risk of heart attacks. We wanted to determine what opportunities exist to apply the 2004 American Heart Association [AHA] guidelines for cardiovascular disease prevention in women, especially in a managed care environment,"reported lead author Lori Mosca, MD, PhD, in Circulation: The Journal of the American Heart Association (February 1, 2005).

The AHA guidelines recommended low-density lipoprotein (LDL; "bad") cholesterol fall under 100 mg/dL, or highdensity lipoprotein (HDL; "good") cholesterol be >50 mg/dL, triglycerides be <150 mg/dL, or non-HDL (a combination of all bad forms of cholesterol) be <130 mg/dL.

For the study, the researchers looked at a managed care database of 1.1 million and found 8353 women who had heart disease at the beginning of the 3-year study or were at greater risk because of diabetes or cardiac risk factors and had not recently been on cholesterol-lowering therapy. The researchers tracked the laboratory and pharmacy information for the participants to decide how physicians managed their care. The researchers then determined how many participants achieved the targeted levels based on the AHA's guidelines for women.

"We found only 7% of these high-risk women had optimal levels of all cholesterol measurements at the start of the study. This improved to 12% after 3 years, still far short of where we would like to see these high-risk women,"said Dr. Mosca. "We also found that only about one third of women were receiving cholesterol-lowering medications, such as statin therapy, as recommended by national guidelines."