Management of dyslipidemia in African Americans: How does Medicare Part D impact?

The Association of Black Cardiologists, Inc. (ABC) held a symposium in Chicago, Illinois, in October 2006 highlighting the need to manage lipids and multiple risk factors in African Americans, as well as the potential impact of the Medicare Part D drug prescription program on this population. Highlighted were data related to the high prevalence of hypertension, left ventricular hypertrophy, diabetes mellitus, cigarette smoking, obesity, and physical inactivity. Keith C. Ferdinand, MD, ABC chief science officer and clinical professor in the Cardiology Division at Emory University, detailed the need to intensively address multiple risk factors and to recognize many of the inherent barriers when treating African Americans. A few of the patient-related barriers include lack of awareness of disease and consequences, distrust of medical professionals, delayed diagnosis, adverse view of medications, and inadequate resources to support a healthful lifestyle. Similarly, physician-related barriers include lower outcome expectations, lack of clinical guideline adherence, and failure to treat blood pressure and lipids early, aggressively, and to target.

As a result of the need for clinicians to better understand how the new Medicare Prescription Program (Medicare Part D) will impact patient care, the symposium also featured Stephanie H. Kong, MD, who described the history of Medicare and detailed just how Part D works. Dr Kong, principal of MetroHealth Group of America and vice president of Medical Affairs for Community Health Choice, suggested that physicians educate themselves regarding the nuances of Medicare Part D and be prepared to address their elderly patients’ needs, especially those with low incomes who potentially face large, out-of-pocket expenses due to the change. She also noted the distressing potential if a patient’s annual drug costs are between $2251-$5100, the range that would compel them to pay for 100% of the cost, the so-called Medicare Part D “doughnut hole.”

Among all racial or ethnic groups in the United States, African Americans have the highest rate of coronary heart disease (CHD) death. Dr Ferdinand is the principal investigator of the African American Rosuvastatin Investigation of Efficacy and Safety (ARIES) trial, the largest prospective trial ever comparing lipid-modifying treatments in African Americans patients. In this study, Dr Ferdinand and his coauthors noted that African Americans have not been adequately represented in clinical end-point trials of lipid-lowering therapies and there is a need for additional studies to better define the clinical response to such treatment in this population. His final recommendations were that lifestyle becomes the cornerstone of care with more aggressive screening and increased focus on comprehensive, culturally sensitive risk management that may increase blood pressure control and decrease cardiovascular morbidity and mortality in African Americans, Hispanics, and other racial and ethnic groups.