• John Z Ayanian, Bruce E Landon, Mary Beth Landrum, James R Grana, and Barbara J McNeil.
• Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. ayanian@hcp.med.harvard.edu
• J Gen Intern Med. 2002 Feb 1; 17 (2): 9510295-102.

ObjectiveTo assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction.DesignTelephone survey and administrative data.SettingNational managed-care company.ParticipantsSix hundred ninety-six adults age 30 to 64 surveyed in 1999, approximately 1 to 2 years after a myocardial infarction.MeasurementsUse of cholesterol-lowering drugs, beliefs about the importance of lowering cholesterol, and knowledge of personal cholesterol level, adjusting for demographic and clinical factors with logistic regression.Main ResultsAmong respondents, 62.5% reported they were taking a cholesterol-lowering drug. In adjusted analyses, these drugs were used significantly less often by African-American patients and those with congestive heart failure or peripheral vascular disease, and more often by college graduates, patients with hypertension, and those who had seen a cardiologist since their myocardial infarction. Lowering cholesterol was viewed as "very important"; by 87.1% of patients, but significantly less often by smokers and more often by those who had undergone coronary angioplasty or bypass surgery. Only 42.5% of respondents knew their cholesterol level, and this knowledge was significantly less common among less-educated or less-affluent patients, African-American patients, and patients who smoked or had diabetes or peripheral vascular disease.ConclusionsAlthough most patients recognized the importance of lowering cholesterol after myocardial infarction, several clinical and demographic subgroups were less likely to receive cholesterol-lowering therapy, and many patients were unaware of their cholesterol level. Health-care providers and managed-care plans can use these findings to promote cholesterol testing and treatment for patients with coronary heart disease who are most likely to benefit from these efforts.

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