Effectiveness of antihyperlipidemic drug management in clinical practice

Although randomized clinical trials have convincingly shown the efficacy of antihyperlipidemic drugs, both discontinuation of antihyperlipidemic drugs and failure to achieve goal lipid levels would be expected to attenuate th e effect of these drugs on reducing the rates of hospitalization for corona ry events. This study compares the rates of hospitalization and low-density lipoprotein cholesterol (LDL-C) levels during and after discontinuation of antihyperlipidemic drug therapy. A retrospective cohort study was conducte d among 2369 patients at 2 health maintenance organizations (HMOs) during t he period 1988 to 1994. Rates of coronary heart disease (CHD)-related hospi talization and non-CHD-related hospitalization and the LDL-C levels between 14 and 180days after the initiation or discontinuation of drug therapy wer e compared for periods of antihyperlipidemic drug use and nonuse. The rate ratio for CHD hospitalization during periods of antihyperlipidemic drug use compared with periods of nonuse was 1.02 (95% CI, 0.74 to 1.40), excluding the first 6 months after initiation or discontinuation and controlling for patient sex, age, history of CHD, hyper tension, diabetes, and HMO site. B y contrast, the adjusted rate ratio was 0.70 (95% CI, 0.61 to 0.80) for non -CHD hospitalization. The percentage of patients with a history of CHD who achieved LDL-C levels <130 mg/dL was 27% less than or equal to 6 months aft er initiation of antihyperlipidemic drug therapy compared with 18% during g aps in drug therapy (P = 0.04). This study failed to demonstrate the effect iveness of lipid-lowering therapy in reducing CHD hospitalizations in commu nity settings, apparently because most recipients either discontinued thera py or failed to achieve the desired LDL-C reduction while receiving therapy . These results indicate the need for interventions to improve patient comp liance and management of lipid disorders.