Lipid-lowering treatment in coronary artery disease: a survey in an ambulatory outpatient clinic

Objectives: In controlled trials, HMG-CoA reductase inhibitors (statins) ef fectively reduced cardiovascular events in patients-with coronary artery di sease (CAD). However. recent pharmacoepidemiological studies indicate an un deruse of statins in the target population. The objective of this study was to examine the extent to which CAD patients in Germany actually received s tatins under field conditions. Methods: We evaluated the medical records of 296 patients referred to the cardiology outpatient clinic of the Frankfurt University Hospital by their general practitioner (GP) in the period 1995 to 1998. All patients had symptomatic, angiographically proven CAD, 142 had previous myocardial infarction. A diagnosis of dyslipidemia was taken from the records. Most patients were visited on more than 1 occasion. In all. w e were able to access 296 records for a 1st visit, 76 records for a 2nd vis it and 29 records for a 3rd visit and 16 records for > 3 visits. Results: A ccording to the entry criteria of the 4S Trial (total cholesterol 5.5 - 8.0 mmol/l or 212 -311 mg/dl), 108 patients were deemed as eligible for lipid- lowering treatment, criteria of the LIPID Trial (4.0 - 7.0 mmol/l or 154 - 270 mg/dl) gave a yield of 190 patients. The actual treatment rate with a s tatin at the 1st visit was 34% (LIPID Group) and 40% (4S Group). At later v isits, the treatment rates with statins increased to 63% (LIPID Group) and 79% (4S Group), due to advice given to the GP by the outpatient clinic. Whe n the observation period was devided into 2 periods (04/95 - 01/97; 02/97 - 09/98), actual treatment rates (all visits) for the 4S Group were 43% and 38%, respectively, indicating no further "penetration" of the 4S Study in t he therapy decision-making of the GPs. Conclusions: The data indicate that necessary treatment with a HMG-CoA reductase inhibitor is often withheld in the ambulatory setting.