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Use and Monitoring of "Statin" Lipid-Lowering Drugs Compared With Guidelines
Susan A. Abookire, MD, MPH;
Andrew S. Karson, MD;
Julie Fiskio;
David W. Bates, MD, MSc
Arch Intern Med. 2001;161:53-58.
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.
Objectives 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.
From the Division of General Medicine, Department of Medicine, Brigham
and Women's Hospital and Harvard Medical School (Drs Abookire, Karson, and
Bates), and Partners Information Systems (Drs Abookire and Bates and Ms Fiskio),
Boston, Mass.
Corresponding author and reprints: Susan A. Abookire, MD, MPH, Division
of General Medicine, Department of Medicine, Brigham and Women's Hospital,
75 Francis St, Boston, MA 02115 (e-mail: sabookire{at}partners.org).
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