(Circulation. 2001;103:2768.)
© 2001 American Heart Association, Inc.
Editorial |
In-Hospital Initiation of Lipid-Lowering Therapy for Patients With Coronary Heart Disease
The Time Is Now
From Ahmanson–University of California Los Angeles Cardiomyopathy Center, Division of Cardiology, University of California Los Angeles (G.C.F.), and the Section of Atherosclerosis, Department of Medicine, Baylor College of Medicine, Houston, Tex (C.M.B.).
Correspondence to Christie M. Ballantyne, MD, Baylor College of Medicine, 6565 Fannin, MS A-601, Houston, TX 77030. E-mail cmb@bcm.tmc.edu
Key Words: Editorials • coronary disease • prevention • hypercholesterolemia • statins • risk factors
In the last 2 decades, in-hospital mortality for acute coronary syndromes and percutaneous and surgical revascularization has decreased markedly. To continue to make progress and to meet the goal set by the American Heart Association (AHA) of reducing coronary heart disease (CHD) and stroke by 25% by 2010,1 the focus of treatment in patients hospitalized with CHD must evolve from treating symptoms of the disease to treating the underlying disease process of atherothrombosis. Although dietary therapy is recommended for all patients with CHD, the recommendations for when to initiate lipid-lowering drug therapy have not been as clear, partly because of a lack of data on the benefits, risks, and costs of immediate initiation of therapy versus delayed initiation after a trial of diet and lifestyle modification.
Numerous studies have shown that the conventional practice of delaying lipid-lowering medications simply does not work as well as algorithm-guided in-hospital initiation of treatment in regard to patients’ being started on therapy, remaining on therapy for the long-term, and achieving target low-density lipoprotein cholesterol (LDL-C) levels. Is there now enough evidence to adopt in-hospital initiation of lipid-lowering therapy in CHD patients as the standard of care?
Despite clinical trials demonstrating that lipid-lowering
medications reduce mortality in patients with established
CHD2 and national guidelines
calling for their use, study after study has demonstrated that these
therapies continue to be underused. Studies of treatment rates for
patients discharged after cardiac hospitalization show a large number
of high-risk patients are not receiving lipid-lowering treatment. An
analysis of
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