Usefulness of in-hospital prescription of statin agents after angiographicdiagnosis of coronary artery disease in improving continued compliance andreduced mortality

Despite well-documented clinical benefit of the use of statins in patients with coronary artery disease (CAD) and even mild lipid elevations, studies have documented the presence of a significant "treatment gap" between those patients in whom treatment is indicated and those patients who actually re ceive it. It has been proposed that a prescription for statin therapy given to indicated patients at the time of initial angiographic diagnosis of CAD has the potential to improve long-term medication compliance, but this req uires further evaluation. We prospectively followed 600 patients with angio graphically demonstrated CAD (diameter stenosis greater than or equal to 70 %) who met the National Cholesterol Education Project (NCEP) guidelines for statin therapy for an overage of 3.0 years (range 2.0 to 4.6). Patients we re an average of 65 years of age, 78% were men, 77% presented initially wit h acute ischemic syndrome, and 64 (10.7%) died during follow-vp. Overall, 1 05 patients (18%) were discharged from the initial hospitalization with a s tatin prescription. At long-term follow-up, the number of patients taking s tatins had increased to 47%. However, long-term statin compliance was signi ficantly higher among patients initially discharged with a statin prescript ion than those who were not (77% vs 40%; p < 0.0001). Additionally, those p atients discharged with a statin prescription had significantly reduced mor tality rate at long-term follow-up (5.7% vs 11.7%; p = 0.05). Cox hazard re gression analysis, controlling for all known clinical baseline variables, c onfirmed the absence of a prehospital discharge statin prescription to be a n independent predictor of increased mortality (hazard ratio 2.4) with a st atistical trend (p = 0.06). Thus, this study demonstrates that after angiog raphic diagnosis of CAD, prescription of appropriate statin therapy at the rime of hospital discharge improves long-term statin compliance and may sig nificantly enhance survival. (C) 2001 by Excerpta Medico, Inc.