After 4S, CARE and LIPID - is evidence-based medicine being practised?

Between 1994 and 1997, three major trials - 4S, CARE and LIPID - showed tha t simvastatin and pravastatin reduced the risk of a recurrent coronary even t in patients with established coronary heart disease (CHD) [Scandinavian S imvastatin Survival Study (4S) Group. Lancet 1993;343:1383-89; Sacks FM et al. New Engl. J. Med. 1996;33:1001-9; Long-term Intervention with Pravastat in in Ischaemic Disease (LIPID) Study Group. New Engl. J. Med. 1998;339:134 9-57]. The results of CARE and LIPID, with pravastatin, also showed that th e benefits of improved survival extended to the majority of patients with C HD whose cholesterol levels were in the 'normal' range. Despite this compel ling evidence, recent CHD prevention surveys between 1994 and 1998 have unv eiled a wide therapeutic gap between scientific evidence and practice in th e secondary prevention of CHD. These recent surveys revealed a high prevale nce of hypercholesterolaemia in patients discharged fi om hospital and afte r 6 months following a coronary event, but low levels of statin prescribing in these patients. Of the minority of patients prescribed a statin by a co nsultant on discharge from hospital, nearly all were still receiving this t reatment in primary care 6 months later. These findings therefore clearly h ighlight the need for an integrated approach involving hospital specialists . primary-care physicians and the patient, to overcome the wide treatment g ap in lowering even 'normal' cholesterol levels in high-risk patients in li ne with evidence-based medicine. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.