Women are significantly less likely than men to have their LDL Cholesterol controlled to recommended levels, according to a new study by the National Committee for Quality Assurance (NCQA). The study, to be published in the May/June edition of Women's Health Issues, investigated gender differences in cardiovascular disease prevention, treatment and risk factors based on national health care quality data from commercial and Medicare managed care plans. Elevated LDL cholesterol is an important modifiable risk factor for cardiovascular disease, the leading single cause of death for both women and men. The study, "Improving the Quality of Care for Cardiovascular Disease: Using National Managed Care Performance Data to Investigate Gender Differences in HEDIS Measures Related to Heart Disease," analyzed data from a national sample of 46 commercial managed care plans and 148 Medicare plans across 11 HEDIS® measures of care for cardiovascular conditions and diabetes. The results, controlled for other factors such as age, income and ethnicity, showed equal or better outcomes for women on most dimensions of care - with the notable exception of cholesterol control, where significant disparities existed between men and women. "This study highlights the importance of not just knowing your health, but also taking an active role in your care," said NCQA President Margaret E. O'Kane. "The data show that we've got our work cut out for us in terms of raising awareness among both physicians and patients." "Women must know their risk for Heart Disease and how to manage it," said Ileana L. Piña, MD, National Go Red For Women Spokesperson and Professor of Medicine at Case Western Reserve University. "These study findings show an opportunity to improve patient care for women and a reason to encourage women to consider seriously how to manage their risk factors, such as elevated cholesterol especially the LDL portion of cholesterol. The American Heart Association's Web site, GoRedForWomen.org, can help. It offers resources and tools for women to understand their risk and how to manage it." The study also looked investigated disparities in care owing to race and income level, and found significant gaps in care. For example, based on the study findings, 55.4 percent of white men with recent cardiac events who were in commercial plans met the recommended lipid control level. For other groups the comparable figures were 46.2 percent for white women, 44.8 percent for African-American men and 34.2 percent for African American women. Similar disparities were found based on income level. These findings suggest that women and their health care providers underestimate risk for high cholesterol and heart disease, leading to poorer cholesterol control among women. The high cost of medications may also be secondary factor. In February, the American Heart Association published updated women's treatment guidelines in Circulation: Journal of the American Heart Association. The guidelines included more aggressive recommendations for high-risk women, including reducing LDL cholesterol to less than 70 mg/dL in very high risk women with heart disease. The study released today demonstrates the need for more focused research to understand better gender disparities. The results of the study will be shared at a congressional briefing on Capitol Hill on May 21, where the study's principal investigator and other experts in health care disparities will discuss clinical and policy recommendations for closing such gaps in care. ### The study was funded by the Agency for Healthcare Research and Quality and the American Heart Association's Go Red For Women movement and its sponsor Bayer. The full study is available on the Web site at the Jacobs Institute for Women's Health at

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