[Changes in the prescription of cardiovascular prevention drugs in France between 1995 and 2003: factors influencing the gap between evidence base medicine and clinical practice].
Dramatic progresses have occurred during the past 10 years in the field of cardiovascular secondary prevention. Many randomized trials have established the efficacy of statins, antiplatelet agents, beta-blockers and ACE inhibitors for reducing cardiovascular mortality, myocardial infarction and stroke in patients with coronary heart disease. Since 2002, American and European guidelines have emphasized the importance of optimal utilization of those four main therapeutic classes. Nevertheless, drugs prescription registries conducted in France since 1995 revealed a persistent gap between evidence based medicine and clinical practice, only a minority of patient received an optimal treatment. Some factors associated with lower rate prescription have been identified: elderly patients, female gender, missing of LDL-cholesterol measurement, history of peripheral artery disease or stroke, and finally the difficulty of observance. At this time, optimization of management of these patients require a systematic measurement of LDL-cholestererol level for all patients with CAD, PAD or history of stroke, a larger prescription of statins in female patients and in elderly particularly for secondary prevention. Increasing observance which is the main challenge could involved the utilization of fixed drugs associations.
Philippe
François
F
Institut mutualiste Montsouris, département de pathologie cardiaque, Paris, France. francois.phillippe@imm.fr
Cambou
Jean-Pierre
JP
Danchin
Nicolas
N
Thomas
Daniel
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015510:Clinical Medicine; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors