title: Are high coronary risk patients missing out on lipid-lowering drugs in Australia?
abstract: OBJECTIVE
  To examine whether high coronary risk patients in Australia, where use of lipid-lowering drugs (LLD) is very high by international standards, are receiving LLD.
  
  
  METHODS
  Assessment of Pharmaceutical Benefits Scheme pharmacy payment claim records between January 2006 and May 2013 for a 10% random sample of Australian concession card holders. Co-prescriptions were used as a surrogate for high coronary risk groups - coronary heart disease (CHD): antiplatelet drugs (not including solo aspirin) and anti-anginal drugs; diabetes: all standard drugs; hypertension: all standard drugs (not including solo diuretics).
  
  
  METHODS
  Proportions of patients in high-risk groups not receiving LLD (statins, fibrates or ezetimibe).
  
  
  RESULTS
  The database yielded information on 276,212 patients defined as being at high coronary risk (mean age, 66.1 [SD, 14.8] years; 44% male). Of this group, 115,477 patients (42%) had not received any LLD during the study period. For patients in the risk group for CHD in combination with diabetes and hypertension, only 8% (1111/14,257) were not receiving LLD. Across all risk groups, the proportions not receiving LLD were generally highest in those aged ≥ 81 years and, to a lesser extent, < 41 years, and were lowest in those aged 51-70 years.
  
  
  CONCLUSIONS
  A large proportion of concession card holders at high coronary risk, especially those in middle age with CHD and multiple risk factors, are being appropriately prescribed LLD in Australia.
authors.affiliation: Lipid Research Department, University of New South Wales and St Vincent's Hospital, Sydney, NSW, Australia. l.simons@unsw.edu.au.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Simons
authors.affiliation: Prospection Pty Ltd, Sydney, NSW, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D057286:Electronic Health Records; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents