Use and monitoring of "statin" lipid-lowering drugs compared with guidelines.
BACKGROUND
In patients with high cholesterol, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (or "statins") have been shown to reduce overall mortality in primary and secondary prevention. The National Cholesterol Education Program expert panel's guidelines (Adult Treatment Panel II) recommend evaluation and treatment of high cholesterol based on stratification of patients according to cardiovascular risk. While evidence suggests that many patients are undertreated, comparatively few data are available regarding overtreatment.


OBJECTIVE
To assess the appropriateness of statin therapy compared with national guidelines and to examine the appropriateness of monitoring for adverse effects.


METHODS
For all patients at a tertiary medical center, electronic medical records were evaluated for presence or absence of statin use and for presence of established coronary heart disease or cardiac risk factors. Therapy was compared with the recommendations of the National Cholesterol Education Program guidelines. Our primary outcome measures included, for all patients taking statins, prevalence of appropriateness vs overuse, and for all patients with coronary heart disease, prevalence of appropriateness vs underuse.


RESULTS
Overuse of statin therapy was found among 69% of patients undergoing primary prevention, and among 47% of patients undergoing secondary prevention. In addition, among patients with coronary heart disease who were not taking statins, 88% were undertreated. Monitoring of liver function varied widely, and did not correlate with the risk of adverse events secondary to statin use.


CONCLUSIONS
Overtreatment and undertreatment for hyperlipidemia were frequent. Decision support may help physicians improve their performance compared with guidelines.
Abookire
S A
SA
Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. sabookire@partners.org
Karson
A S
AS
Fiskio
J
J
Bates
D W
DW
D000328:Adult; D003327:Coronary Disease / Q000150:complications / Q000517:prevention & control*; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000150:complications* / Q000188:drug therapy*; D008111:Liver Function Tests / Q000191:economics; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics*; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors