Vermillion among communities in state showing highest cholesterol drug use Pills are good, but no magic bullet by David Lias Lipitor¨. Zocor¨. Pravachol¨.
Prescription drugs to treat high cholesterol have become household names for South Dakotans and Wellmark Blue Cross and Blue Shield members who gobbled up more than $33.7 million of cholesterol medication in 2002.
Wellmark Blue Cross and Blue Shield reports that more than half of that amount went for one drug � Lipitor.
Its study of cholesterol remedy use in the state also reveals that Vermillion is among five South Dakota communities with the highest usage of these prescription medications.
The findings are published by Wellmark in "The Wellmark Report" and its companion consumer fact sheet, "Cheeseburgers & Lipitor Don't Mix."
South Dakotans are right in step with the rest of the nation in the use of these drugs. In 2002, Lipitor and Zocor were the number one and number two selling drugs in the United States, ringing up $10.3 billion in sales. This class of drugs, also known as statins, has experienced double-digit growth over the past five years.
"We want people to be on cholesterol-lowering drugs, when it's appropriate, because we know it can prevent heart disease by reducing cholesterol levels by 20 to 45 percent," said Dr. Dale Andringa, Wellmark's chief medical officer. "But it's important for South Dakotans to realize that these drugs are not a magic bullet in the fight against heart disease. The American Heart Association recommends that cholesterol drug therapy be introduced only after improvements in exercise and diet have been unsuccessful."
Cholesterol is a fat that humans naturally produce, and it is found in meat and dairy products. People need a certain amount of cholesterol, and genetics can cause some people to
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produce too much cholesterol. Individuals with too much in their bloodstream can eventually experience a blockage in the flow of blood to their hearts. That is why it's important for everyone to know their cholesterol numbers.
"It's interesting to note that Vermillion is in the top five for 2002," said Dr. Sheila Riggs, vice president and director of The Wellmark Report, "and actually we looked at three years of data � 2000, 2001 and 2002 � and Vermillion was in the top five all three years."
The number of South Dakotans using brand name, prescription cholesterol-lowering drugs such as Lipitor¨ and Zocor¨ is below the national rate, but it is up 12 percent over that three-year period, Riggs said. Of those prescriptions, in South Dakota, just 9 percent were of a generic form.
"What is surprising is the tremendous amount of variation we saw community-by-community across South Dakota," Riggs added. "For example, twice as many people in Vermillion are using these drugs as in Rapid City."
She said Wellmark feels there is a moral imperative for communities to know this information.
"Health care providers, physicians, community leaders, employers who care about keeping their employees healthy and yet affording health insurance can see where they are the same or higher or lower compared to their neighbors," Riggs said.
Riggs holds two doctorates in health care, including a doctorate of medical science in epidemiology from the Harvard Medical School.
She is employed exclusively as an epidemiologist for Wellmark.
Riggs cites two major factors contributing to the increase in cholesterol-reducing drug use � public awareness and a recent revision in cholesterol-related health guidelines.
"We want people to know their cholesterol numbers," she said, "and to work with their physicians on the range of things that need to be done to make them healthy.
"It is very much linked to heart disease. There's also a lot of advertising about Lipitor¨and Zocor¨."
According to National Cholesterol Education Program (NCEP) guidelines, an individual's total cholesterol should be less than 200. A person's LDL � or "bad" cholesterol � should be less than 130, and HDL level � or "good" cholesterol � should be more than 40.
A person's triglycerides should be below 150. These baseline numbers are for individuals without other health risks such as diabetes.
The NCEP revised its recommendations in May 2001 and began advising individuals to start taking cholesterol-lowering drugs when their LDL or "bad" cholesterol level is 130 or above, even if they have only one or no risk factors for heart disease.
That NCEP revision could be a factor in the recent growth of cholesterol-lowering drug use.
"I think that you could talk to physicians in Vermillion and see that they have really engaged in those guidelines and in working closely with their patients," Riggs said.
More and more Wellmark members are using cholesterol-lowering prescription drugs. Prescriptions for these drugs by Wellmark members skyrocketed 128 percent from 1999 to 2002, according to The Wellmark Report.
"We wanted to present information so that people start to recognize that their personal decisions do matter, they do count toward a role in keeping health insurance premiums as low as possible at a time when they should know about their own health," Riggs said.
The report shows cholesterol-lowering drug use in South Dakota is 58 per 1,000 members, as compared to the national rate of 61 per 1,000. Miller, Sisseton, Tyndall, Vermillion, and Wagner have the greatest utilization, with a range of 71 per 1,000 to 96 per 1,000.
The study found that Vermillion's use among Wellmark Blue Cross Blue Shield members is 84 per 1,000 members, significantly higher than both the state and national rates.
"For every 1,000 people we insure in Vermillion, 84 of them have filled a prescription for a cholesterol-lowering drug at least once in 2002," Riggs said.
Custer, Gettysburg, Lemmon, Rapid City, and Sturgis have the lowest usage, with a range of 38 per 1,000 to 43 per 1,000.
"We just are presenting the facts," Riggs said, "and there could be a wide range of reasons why there is that big of a difference. We hope that this does engage in dialogue in communities like Vermillion and Rapid City to understand how could there be this big of a difference."
Cholesterol-lowering drugs, she said, are "absolutely" within the range of things that need to be done to help make people healthy.
"Absolutely, cholesterol-lowering drugs are in that repertoire," Riggs said. "We know that a lot of people have to be on them and they are effective. We know they are also costly. It helps everyone understand why health care costs are on the rise.
"When people think 'why are health care costs going up?' here is one of the reasons why," she said. "People should know what their cholesterol numbers are, and there are a range of things that can be done to lower those numbers."
People can help keep their cholesterol numbers under control, The Wellmark Report suggests, by controlling blood pressure, getting fewer than 30 percent of calories from fat, watching their weight, walking or some other type of exercise three or four times a week, and reducing stress.
Individuals also should consume less than two alcoholic drinks per day, and should not smoke.
"We don't know where a community will take this," Riggs said, "but we know that, often, actions begin because of some data. We sit on so much information, and we want to use it to help make informed decisions and hopefully make a difference in health care costs."
For additional information, including cholesterol-lowering prescription drug usage by community area and the towns included in each community area, go to http://www.wellmark.com/health_improvement/reports/wellmark_report.htm.
Wellmark, Inc. does business as Wellmark Blue Cross and Blue Shield of Iowa. Wellmark and its subsidiaries and affiliated companies, including Wellmark Blue Cross and Blue Shield of South Dakota, insure or pay health benefit claims for more than 1.7 million members.
Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.