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Aboorkie et al¹ are to be commended for examining an important but understudied topic: the appropriate use of statin drugs in patients with lipid disorders but no history of coronary heart disease. Their finding that 69% of patients who are taking statin drugs for primary prevention do not meet National Cholesterol Education Panel Adult Treatment Panel II (ATP II) guidelines for appropriate use suggests that overuse of pharmacologic cholesterol-lowering therapy is common.

The ATP II guidelines, however, may not be the ideal means of determining appropriateness. Previous research has shown that the ATP II guidelines perform less accurately than an explicit, quantitative risk-based strategy in predicting future coronary heart disease.² In particular, the ATP II guidelines tend to underemphasize the importance of age, perhaps accounting for Aboorkie and colleagues' finding that older age significantly predicted "overuse." It would be interesting to know the proportion of overuse if appropriate therapy were . . . [Full Text of this Article]

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