Statin wars following coronary revascularization--evidence-based clinical practice?
BACKGROUND
Randomized clinical trials (RCTs) have shown that statins provide substantial heath benefits. Pharmaceutical companies spend enormous amounts of money on both clinical trials and marketing. The relative influence of information from clinical trials on physician prescription patterns for statins is unknown.


OBJECTIVE
To examine the correlation between statin prescription patterns and the quality of evidence from RCTs.


METHODS
Using the computerized administrative databases of the Quebec Health Insurance Board, the choice of statin for elderly patients (older than 65 years of age) following a coronary revascularization procedure (percutaneous coronary intervention or coronary artery bypass graft surgery) performed between January 1, 1994, and June 30, 2003, was examined. Prescriptions for each statin were compared with their evidence base obtained from a cumulative systematic literature review of RCTs that recorded mortality as an outcome and were published before December 31, 2002.


RESULTS
The study cohort comprised 27,979 elderly revascularized patients who received at least one statin prescription. In 1996, the year atorvastatin was introduced, simvastatin and pravastatin had 38.3% and 37.1% of the market share, respectively. By 2003, atorvastatin had 44% of the market share, compared with 29.9% and 24.1% for simvastatin and pravastatin, respectively. In contrast, RCTs published up to the end of 2002 had culminated in 133,341 and 140,565 patient-years of follow-up for simvastatin and pravastatin, respectively, and only 1459 patient-years for atorvastatin.


CONCLUSIONS
Prescription patterns regarding the choice of statin do not appear to be determined uniquely from high-quality RCTs. Further research into the other possible determinants of physician prescription patterns is necessary.
Brophy
James M
JM
Division of Cardiology, Royal Victoria Hospital/McGill University Health Center, Montreal, Quebec. james.brophy@mcgill.ca
Costa
Vania
V
D000368:Aged; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008148:Lovastatin / Q000627:therapeutic use*; D008297:Male; D017202:Myocardial Ischemia / Q000628:therapy*; D009204:Myocardial Revascularization; D010045:Outpatients; D011182:Postoperative Care / Q000379:methods; D017035:Pravastatin / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008148:Lovastatin; D019821:Simvastatin; D017035:Pravastatin