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Lipid-lowering drugs are underused in patients hospitalized with recurrent heart attacks

Patients with both established coronary artery disease (CAD) and high cholesterol (hyperlipidemia) are at 10 times greater risk of dying than high-cholesterol patients without overt CAD. Yet, a new study found that only one-third of heart attack patients who were eligible to take lipid-lowering drugs (LLDs) were taking them at the time of hospital admission. What's more, only a tenth of these high-risk patients with untreated hyperlipidemia (total cholesterol above 240 mg/dL) were discharged from the hospital with a prescriptions for LLDs. Elderly patients in particular were less likely to be treated with LLDs, even though studies have shown that they have a 30 percent risk of death 1 year after heart attack compared with a 5 percent risk for younger patients.

The undertreatment of high blood cholesterol levels in this vulnerable population could be corrected by starting heart attack patients on LLDs during hospitalization in conjunction with modification of behavior and diet. Overall, if all of the eligible but untreated patients had used LLDs for 5 years before their admission, about 15 heart attacks or cardiovascular deaths might have been prevented, notes principal investigator Stephen B. Soumerai, Sc.D., of Harvard Medical School. In the study supported in part by the Agency for Healthcare Research and Quality (HS07357), first author Sumit R. Majumdar, M.D., M.P.H., Dr. Soumerai, and their colleagues analyzed the medical records of 2,938 patients hospitalized for heart attack at 37 community hospitals in Minnesota during 1995 and 1996.

Of these, 622 patients had a history of CAD and hyperlipidemia and were eligible for LLDs. However, only 37 percent of eligible patients received LLDs, and 89 percent of untreated patients were discharged from the hospital without an LLD prescription. Of the patients who were using LLDs, only 15 percent achieved the recommended goal of a total cholesterol below 160 mg/dL. Patients who used two or more LLDs were more apt to achieve blood cholesterol goals than patients who used only one LLD (31 percent successful vs. 14 percent).

More details are in "Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease," by Sumit R. Majumdar, M.D., M.P.H., Jerry H. Gurwitz, M.D., and Dr. Soumerai, in the December 1999 Journal of General Internal Medicine 14, pp. 711-717.

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