Rationale, design, and baseline results of the pravastatin-to-simvastatin conversion lipid optimization program (PSCOP)

A program designed to increase the percentage of patients at a Department o f Veterans Affairs health system who meet their cholesterol goals as recomm ended by the National Cholesterol Education Program (NCEP) is described, an d baseline results are reported. Patients with an active prescription for pravastatin between February 4 and June 4, 1997, were identified for conversion to simvastatin by means of th e Pravastatin-to-Simvastatin Conversion Lipid-Optimization Program; 1361 pa tients were eligible for conversion. Each patient was mailed a survey for d etermining risk factors for coronary heart disease (CHD) and NCEP-recommend ed low-density lipoprotein (LDL) cholesterol goal and was asked to provide a fasting blood sample for determination of lipid profile, liver function, and serum creatine phosphokinase concentration. The patients were asked to make a follow-up laboratory visit six to seven weeks after they had started taking simvastatin. The percentage change from baseline and the percentage of patients who meet their LDL cholesterol goal before and after the conve rsion will be determined. A total of 1115 patients were converted to simvastatin. Only 35.4% of patie nts taking pravastatin to prevent a second CHD-related event met or exceede d their LDL cholesterol goal. Only 36.2% of patients with two or more CHD r isk factors who were taking pravastatin for primary prevention met or excee ded their LDL cholesterol goal. In a veterans population, less than half of patients receiving a 3-hydroxy- 3-methylglutaryl coenzyme A reductase inhibitor had LDL cholesterol concent rations that met goals recommended by the NCEP.