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Statins More Effective When Begun in Hospital

Patients given them during treatment likelier to stay on them

MONDAY, Nov. 24, 2003 (HealthDayNews) -- When you start cholesterol-lowering drugs in the hospital after being treated for a heart problem, you are more likely to stick with them than if you start taking them after you're sent home, a new study finds.

"Although we know that cholesterol-lowering drugs called statins substantially reduce the toll that cardiac disease takes on our society, these agents are tremendously underutilized," says lead researcher Dr. Herbert D. Aronow, an associate professor of medicine at the University of Pennsylvania Medical Center.

"We know these agents reduce death from cardiovascular disease, the chance of having a heart attack, the chance of having a stroke, and even the need to undergo bypass surgery or/and angioplasty. But despite that, few people who ought to be on these drugs are," he adds.

Aronow's group collected data from patients at 69 centers in the United States and Canada participating in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial.

In this trial, patients who were hospitalized for treatment for heart disease were randomly selected to receive a placebo or cholesterol-lowering drugs.

Among these patients, 175 were taking lipid-lowering drugs at discharge and 1,951 were not. Patients not taking these drugs at discharge had them prescribed by their doctors later, according to the report in the Nov. 24 issue of the Archives of Internal Medicine.

During six months of follow-up, Aronow's group found 77 percent of the patients who started taking lipid-lowering drugs in the hospital continued taking them, compared with 25 percent of the patients who left the hospital without receiving lipid-lowering therapy.

"We found that initiation of lipid-lowering agents before discharge was the most important independent predictor of their use at follow-up," the authors note. "In fact, patients in whom lipid-lowering therapy was initiated before discharge were nearly three times as likely to be taking these agents six months later."

When patients are in the hospital, it is an ideal opportunity for physicians to start these medications, Aronow says. "You've got patients who are motivated. You're right there and you can suggest to them that these medications are beneficial, and patients are likely to stay on them."

If starting these medications is deferred until later, it appears this message falls through the cracks, he adds.

"If you have plaque buildup in your arteries, and you are not on a cholesterol-lowering drug, you need to discuss this with your doctor," Aronow advises.

Aronow adds that you do not have to have high cholesterol to be on these drugs. "Just about anybody with plaque buildup in the arteries, regardless of cholesterol level, ought to be on one of these drugs."

Dr. Myron H. Weinberger, a professor of medicine at Indiana University Medical Center, comments that this is a most impressive finding.

However, he says, "it is difficult to know whether the findings were the result of more compulsive physicians, who believe in the benefit of statin therapy for people after heart attacks, so that they administered the drug in the hospital."

"There may also be a concern on the part of the patients that medicine given to them in the hospital may be more important than that which is added later on," he adds.

Many of the patients in the study should have been on statins before their heart attack, Weinberger says.

"If you have had a heart attack or acute coronary syndrome, you should be on a statin. Because whatever your cholesterol levels are, they're too high; otherwise, you wouldn't have had the event," he says.

"If your physician doesn't give it to you, you should ask for it," Weinberger stresses.

More information

To learn more about cholesterol and cholesterol-lowering medications, visit the American Heart Association or the National Heart, Lung, and Blood Institute.

SOURCES: Herbert D. Aronow, M.D., M.P.H., director, cardiac catheterization laboratory, Philadelphia Veterans Affairs Medical Center, assistant professor, medicine, and director, peripheral intervention, University of Pennsylvania Medical Center, Philadelphia; Myron H. Weinberger, M.D., professor, medicine, and director, hypertension research center, Indiana University Medical Center, Indianapolis; Nov. 24, 2003, Archives of Internal Medicine
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