In a paper in this month's PLoS Medicine
, Jun Ma and colleagues from Stanford University Medical School found that levels of statin prescribing were well below the recommendations of current guidelines. They showed that in 2002, statins were prescribed in just 50% of consultations for people at high risk of coronary heart disease and 44% of those at moderate risk. In addition, in less than half the visits patients received counseling about how they might change their lifestyle.
The authors analyzed data from the National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey, surveys that have been validated against other data sources, and used in past research on cholesterol management. They also showed inequities in use of statins for patients with different social and clinical characteristics, with lower usage in younger patients, females, African-Americans, and patients cared for by doctors who are not cardiologists.
Coronary heart disease is the leading cause of morbidity and mortality in developed countries, and identifying and treating patients with high cholesterol has an essential role in the prevention of CHD. Therapeutic lifestyle changes are important for general reduction of risk overall, but patients who are more likely to develop CHD, or who have high cholesterol, should be treated with statins. The authors conclude that education should be aimed at improving the practice of physicians, above all those who are not heart specialists, so that they adhere to evidence-based medicine and published guidelines for cardiovascular risk reduction.
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Contact: Paul Ocampo
Public Library of Science
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