How do prescribing doctors anticipate the effect of statins?
OBJECTIVE
Statins are a lipid-lowering treatment, prescribed frequently to prevent cardiovascular events. The objective of this study was to explore how doctors anticipate the effect of statins and what factors are associated with their willingness to initiate treatment.


METHODS
A total of 330 Swedish cardiologists, internists and general practitioners were asked to consider two hypothetical patient cases, one with and one without previous coronary heart disease. Based on these cases, the respondents answered questions about their willingness to initiate treatment and what effects they might expect. The expectation of effect was assessed in two ways: (1) the absolute risk reduction of myocardial infarction in 1000 patients treated with statins for 5 years; and (2) statins' average effect on increased life expectancy. The doctors' beliefs about absolute risk reduction were compared with results from clinical trials.


RESULTS
Most doctors had a suboptimal expectation about absolute risk reduction; only about one-third had expectations in the range supported by evidence-based data. There were different views about statins' ability to prolong life: that is, average gain in life expectancy due to treatment was believed to be 2 years in the primary patient case, and 3 years in the second patient case. The doctors' beliefs about statins' ability to prolong life were associated significantly with their willingness to initiate treatment.


CONCLUSIONS
The overall results imply that doctors have varying and suboptimal understanding of the effect of statins. This may inhibit the goal of integrating clinical research into clinical practice.
Lytsy
Per
P
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. per.lytsy@pubcare.uu.se
Burell
Gunilla
G
Westerling
Ragnar
R
D003327:Coronary Disease / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008017:Life Expectancy; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000517:prevention & control*; D010820:Physicians / Q000523:psychology*; D018570:Risk Assessment; D012737:Sex Factors; D013548:Sweden; D013997:Time Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents