Only Half of Patients Receiving Statins Achieve Maximum Benefit

Peggy Peck

September 02, 2003

Sept. 2, 2003 (Vienna) — Although there has been a consistent increase in the number of patients initiating statin therapy, new research from the U.K. suggests that less than half of patients started on a statin are treated to goal, and thus the promise of statins for cardiovascular disease prevention may be largely unrealized. The findings were reported here Sunday at the European Society of Cardiology Congress 2003.

Evo Alemao, PhD, program manager for outcomes research at Merck & Co. in Whitehouse Station, New Jersey, told Medscape that the problem seems to be caused by poor physician follow-up.

Of 19,898 patients in the U.K. initiated on lipid-lowering therapy from 1998 to 2001, 18,847 (95%) were started on a statin. The rate of new-statin patients doubled from 4.4 per 1,000 patients in 1998 to 8.5 per 1,000 in 2001, suggesting no reluctance to initiate statin therapy.

Atorvastatin was the most commonly prescribed statin, with 25.8% of patients receiving 10 mg and 4.2% started at 20 mg. Simvastatin 10 mg was prescribed for 24.7% of the patients, and simvastatin 20 mg was prescribed for 13.7% of the patients.

Follow-up is clearly a problem; the researchers found that overall less than 30% of patients were titrated to a higher dose; 18% of patients discontinued therapy within less than three months of initiation; 60% allowed prescriptions to lapse for 60 days or longer; 43.4% had no baseline total cholesterol record; and 34.2% of patients had no record of follow-up cholesterol measurements.

Among patients who did have baseline records, 45% never achieved goal cholesterol levels. Worse, the percentage of patients who achieved their cholesterol goal declined as baseline total cholesterol levels increased; thus, patients with the highest total cholesterol were least likely to achieve their cholesterol goal, said Dr. Alemao.

Patient compliance is an issue, said Sidney Smith, Jr., MD, professor of medicine and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina in Chapel Hill. "Getting people to stay on their cholesterol medication is a continuing problem," Dr. Smith told Medscape.

Moreover, Dr. Smith, who was not involved in the U.K. study, said it provides some encouraging data. While the number of patients who reached their goal is low, the numbers are constantly improving, he said.

"This looks like progress," Dr. Smith said. "In the 1990s we were getting about 25% of people to goal." And, he pointed out, unlike most studies that suggest people who would benefit from statins are not getting the drugs, the U.K. study suggests that increasing numbers of patients are starting statins, which he said counts as progress.

In recent years there has been a concerted effort to "initiate drug treatment — statins particularly — in the hospital, before a patient is discharged," said Dr. Smith, who is a former president of the American Heart Association. This hospital-based therapy approach does appear to increase the use of statins, but more is needed. "Doctors also need to reinforce the need for these drugs," he said. "The second phase of quality improvement has got to be in the out-hospital setting."

ESC Congress 2003: Abstract 633. Presented Aug. 31, 2003.

Reviewed by Brunilda Nazario, MD

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