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Impact of high dose statin trials on hospital prescribers

Thomas I Barron1, Kathleen Bennett, John Feely

  • 1Department of Pharmacology and Therapeutics, Trinity College Dublin, St Jame's Hospital, Dublin 8, Ireland. barront@tcd.ie

European Journal of Clinical Pharmacology
|November 23, 2006
PubMed

Insights

Hospital doctors increased atorvastatin prescribing doses after key studies showed its effectiveness. This shift reflects the impact of clinical trial results on medical practice for coronary heart disease prevention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • PROVE-IT and REVERSAL studies demonstrated atorvastatin's superiority over pravastatin for secondary prevention of coronary heart disease (CHD).
  • Intensive atorvastatin (80 mg/day) proved more effective than standard pravastatin (40 mg/day) in managing acute coronary syndromes and limiting atherosclerosis progression.

Purpose of the Study:

  • To evaluate the influence of the PROVE-IT and REVERSAL trial findings on hospital physicians' prescribing habits for atorvastatin.
  • To analyze changes in atorvastatin dosage prescribed by hospital doctors in the two years following these pivotal study publications.

Main Methods:

  • Utilized a nationwide database of 18,894 patients with 23,750 hospital discharge prescriptions for atorvastatin (Sept 2002 - Dec 2005).
  • Identified patients newly started, switched, or dose-titrated on atorvastatin by hospital prescribers.
  • Analyzed monthly mean daily atorvastatin doses at discharge using segmented regression analysis.

Main Results:

  • Observed a significant and sustained increase in the mean atorvastatin dose prescribed by hospital doctors.
  • The average atorvastatin dose increased by 12 mg by December 2005.
  • Prescribing of 20 mg, 40 mg, and 80 mg daily doses increased by 16.4%, 17.2%, and 8.8%, respectively.

Conclusions:

  • The PROVE-IT and REVERSAL studies significantly influenced hospital prescribers' selection of atorvastatin dosage.
  • The observed changes in prescribing patterns are likely attributable to the publication and effective promotion of these trial results.
Abstract

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