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2/1/2001

Overuse, Underuse of Statins Found to Be Common

Kate Traynor

Despite the existence of national guidelines for the use of lipid-lowering statin drugs, many people who would benefit from these agents do not take them, and many of the people who use statins should not.

Researchers at Brigham and Women’s Hospital recently reported that 88 percent of patients with heart disease who had not been taking a statin satisfied the usage criteria spelled out by the National Cholesterol Education Program (NCEP) and their health care provider should have prescribed a statin. Among heart disease patients who had been taking a statin, only 53 percent satisfied the NCEP criteria, indicating that this class of drugs had been inappropriately prescribed to a large percentage of patients.

Inappropriate statin use was particularly high among patients taking the drug to prevent the onset of heart disease—69 percent of these statin users did not meet NCEP criteria. Overuse of statins was most common in that primary prevention subset and among patients 70 or more years of age and those with less than two risk factors for cardiac disease.

An economic analysis that took into account laboratory and drug costs revealed that payers could have saved an estimated $1.3 million had statin use among the nearly 30,000 patients served by the hospital and its affiliated sites accorded with NCEP guidelines.

Data for this report, which was published in the Jan. 8 Archives of Internal Medicine, was obtained from the electronic outpatient records for 29,543 patients treated at Brigham and Women's facilities during 1996. The electronic records contained information about the patients’ diagnoses, comorbid conditions, and laboratory test results as well as prescribing data. This information was used to identify indications for and contraindications to statin use among the patients.

According to lead author Susan A. Abookire, M.D., M.P.H., the research team initially found a total of 1,575 statin users—495 of whom had coronary heart disease—in the database. A second probe of the database at a different time revealed that 544 of 2,003 patients who had heart disease used a statin. The average statin user was 63 years old, and 60 percent of the people taking a statin were women.

The researchers found no correlation between a patient’s total cholesterol level and the likelihood that the person’s total or high-density-lipoprotein (HDL) cholesterol fraction would be monitored during the study year. There was a "modest" correlation between low-density-lipoprotein (LDL) cholesterol monitoring and total cholesterol level.

Six percent of the statin users concurrently received a medication considered likely to interact with the statin, possibly leading to a change in liver function. These patients did not undergo more frequent screening of liver function than did other statin users. There were no clinically important adverse drug reactions associated with statin use by these patients during the study year.

According to the NCEP guidelines, high blood cholesterol should be treated when possible with a dietary regimen, reserving drug therapy for patients at high risk for heart disease. The guidelines make heavy use of LDL and HDL cholesterol values in determining risk factors for heart disease. On the basis of the study’s findings, the research team recommended that decision-support mechanisms be used at the point of prescribing to improve adherence to the NCEP guidelines.

The study was funded in part by Aetna U.S. Healthcare Inc.