Physicians Should Prescribe Cholesterol-lowering Medicines More to Select Patients While Still Hospitalized

University of Pennsylvania School of Medicine
Tuesday, 25 November 2003

Study finds that this could improve quality of life for patients with cardiovascular diseases

Although cholesterol-lowering agents have been shown to dramatically reduce the likelihood of cardiovascular diseases, few people who qualify for these drugs actually receive them. A study published in the current issue of Archives of Internal Medicine suggests that increasing the appropriate use of cholesterol-lowering therapies – while the patients are still in the hospital – could translate into improved clinical outcomes.

Herbert Aronow, MD, MPH, Assistant Professor of Medicine at the University of Pennsylvania School of Medicine, and researchers at the Cleveland Clinic studied more than 2,100 patients at nearly 70 United States and Canadian hospitals undergoing heart angioplasty in the EPILOG trial. The researchers asked the question: 'If patients with cardiovascular disease are hospitalized, does it matter whether cholesterol-lowering agents are begun before discharge or whether that decision is deferred to the outpatient setting?' They found two things: first, patients who started the medicine while in the hospital fared better than those who didn't; and second, those patients who started the medications while in the hospital were more likely to continue using the drugs following discharge.

"The bottom line is that we need to capitalize on the opportunity to initiate these life-saving medications in the hospital when our patients are most motivated to alter their lifestyle or medical regimens," said Aronow.

"The findings were remarkable," he continued. "Patients who were started on cholesterol-lowering agents while hospitalized were nearly three times more likely to be taking these medications in follow-up than those who went home without them. Given the well-established benefits associated with cholesterol-lowering drugs and the high prevalence of cardiovascular disease, any strategy that leads to increased drug utilization could have a tremendous impact on our societal health."

Atherosclerosis, the build-up of fatty deposits ('plaque') inside the body's arteries is the leading cause of death and disability worldwide. This disease is responsible for most heart attacks and strokes and ultimately leads millions of patients worldwide to undergo heart angioplasty and bypass surgery each year.

"Cholesterol-lowering agents, such as statins, reduce the chances of dying, having a heart attack or stroke or needing angioplasty or bypass surgery by roughly one third," said Aronow. "Nevertheless, recent surveys revealed that only one to two-thirds of eligible patients are prescribed these medications. Further, among those taking these medications, most are on too low a dosage to be clinically effective."

He also cautioned that, "despite the substantial health benefits attributed to these medications, they are no substitute for a healthy lifestyle. Diet, exercise and smoking cessation are the cornerstones of prevention and should be considered as complementary to, not in place of, medical therapy."

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