Under prescribing of statins puts more people at risk of premature death

May 31 2005

A new study out of Stanford School of Medicine says that cholesterol-lowering drugs known as statins that can help prevent heart disease are still underprescribed for many at-risk patients.

Study author Dr. Jun Ma, a research associate at the Stanford Prevention Research Center says that only 50 percent of high-risk patients who visit doctors receive statins and people may die prematurely because of inadequate treatment. Ma says that people who should receive these drugs but don't are put at greater risk of heart disease.

Each year, more than half a million people die from heart disease, which along with cancer is one of the nation's leading killers.

Statins and blood-pressure medications such as beta blockers, are important because they reduce the risk factors that cause heart disease. Statins cut cholesterol production in the liver and boost the organ's ability to remove a "bad" cholesterol known as LDL.

A renewed emphasis on how lifestyle factors, including exercise and diet, can reduce heart disease risks was called for in the study, as was the importance of Cholesterol checks for adults.

Senior author of the study Dr. Randall Stafford, an associate professor of medicine at the Stanford Prevention Research Center, says risk-lowering lifestyle changes are still overlooked and one of the problems is that turning this evidence into practice has not been effective.

Apparently this study is the first to examine how statin therapy varies according to the risk of heart disease among U.S. outpatients.

The researchers examined two national databases that track outpatient visits to hospitals and physicians between 1992 and 2002, and the medications prescribed or renewed during those visits. The results were compared with the number of patients who had been diagnosed with high cholesterol levels and varying degrees of risk for heart disease.

Among patients with high cholesterol in moderate and high-risk groups, the researchers found fewer than half of patient visits in 2002 ended with a statin recommendation. Use of these drugs overall grew during the decade, but doctors said the drugs were still underused, in particular among moderate-risk patients.

Ma says that if compared to the number of patients who would benefit from these drugs, the degree of increase is less than what would be expected.

The study was funded by Merck Co., which manufactures statins Zocor and Mevacor, and by the Agency for Healthcare Research and Quality.

Dr. Kanu Chatterjee, a cardiologist and medical professor at the University of California, San Francisco, agrees with the findings and says earlier studies have documented how statins are underused among blacks in the United States and among Europeans. Chatterjee who was not involved in the study confirms that there is no question that statins show a tremendous benefit in reducing the rates of heart attack and potentially the risk of strokes.

The study concludes that doctors should aggressively examine patients with a moderate to high risk of heart disease to see if such drugs are appropriate.

The study can be seen in the online journal Public Library of Science Medicine.