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Switching to statins: a challenge for primary care
N G Fisher1, A J Marshall, J Went
1South West Cardiothoracic Centre, Derriford Hospital, Plymouth, Devon, UK. Nick.fisher2@virgin.net
Insights
New guidelines for statins (3-hydroxy-3-methylglutaryl coenzyme A inhibitors) were not widely adopted by patients previously treated for coronary heart disease (CHD). Many patients did not receive appropriate statin therapy, hindering prompt benefit from treatment advances.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Official guidelines for statin use in coronary heart disease (CHD) prevention were issued in England in 1997.
- A study assessed patient adherence to these new guidelines six months post-issuance.
Purpose of the Study:
- To evaluate the adoption of new statin guidelines by patients previously managed by a specialist lipid clinic.
- To identify gaps in statin therapy for primary and secondary CHD prevention.
Main Methods:
- A questionnaire survey was sent to 195 patients discharged from a lipid clinic in 1989, with general practitioner consent.
- Analysis focused on 86 patients with current cholesterol measurements, examining their medication and morbidity over the subsequent decade.
Main Results:
- Of 61 patients receiving primary CHD prevention, only 14 were on statins, and none met the new guideline criteria.
- Of 25 patients receiving secondary CHD prevention, all qualified for statins, but only 14 were prescribed them, with 6 not achieving target cholesterol levels.
Conclusions:
- Statin treatment was not consistently updated to align with new guidelines, potentially delaying patient benefit.
- A coordinated approach to managing CHD risk factors, possibly via a central registry, is recommended for improved patient outcomes.
Abstract:
In 1997, doctors in England received official guidelines on the use of statins (3-hydroxy-3-methylglutaryl coenzyme A inhibitors) for primary and secondary prevention of coronary heart disease (CHD). Six months later we determined the status of patients who had been discharged from a specialist lipid clinic in 1989. 195 patients received questionnaires, with the consent of their general practitioners, regarding morbidity in, the subsequent decade and present medication, and were asked to have their cholesterol checked. Analysis was confined to the 86 with a current cholesterol measurement. Of 61 patients who had been discharged on a regimen of dietary advice and/or medication for primary prevention of CHD, 8 had been changed to a statin and 6 had been started on one. According to the new guidelines, none of these qualified for treatment. Of 25 patients who had been discharged on drugs for secondary prevention, all qualified for a statin but only 14 were receiving one--in 6 cases without achieving the recommended reductions in cholesterol. In many of the patients reviewed, treatment had not been altered to conform with the new guidelines. If hyperlipidaemic patients are to benefit promptly from advances in treatment, one solution might be a central registry that arranged regular tests and reported back to general practitioners. However, since many patients at risk do not have very high cholesterol levels, a coordinated approach to CHD risk factors would be preferable.