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(Circulation. 2008;117:336-337.)
© 2008 American Heart Association, Inc.

Editorial

Using Computer-Based Decision Support to Close the "Know–Do" Gap in Lipid-Lowering Therapy

Jerry Avorn, MD; Niteesh K. Choudhry, MD, PhD

From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Jerry Avorn, MD, Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA 02120. E-mail javorn@partners.org

Key Words: Editorials • cholesterol • computers • drugs • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A strange paradox haunts our attempts to prevent ischemic heart disease. Medicine has addressed the relation between serum lipids and atherosclerosis through a series of scientific triumphs. First, epidemiology demonstrated the association between abnormal cholesterol levels and coronary artery disease. Then, physiology and biochemistry elucidated the pivotal role of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase in the synthesis of lipoproteins. Next, pharmacology led to the development of new medications to target that enzyme without the often-unbearable side effects of earlier drugs. And finally, clinical researchers enrolled tens of thousands of patients at hundreds of centers worldwide to prove the efficacy of these treatments and help guide their use. Taken together, these steps represent one of the finest examples of the application of science to understand and ameliorate human disease.

Article p 371

But shifting our focus from the successful laboratory or clinical trial site to the population reveals more disappointing data. We physicians fail to diagnose potentially dangerous lipid levels in up to a third of our patients with cardiovascular disease^1,2; when the problem is identified, we often do not properly deploy the impressive arsenal of treatments that have been put in our hands. In the United States, fewer than half of those who would benefit from lipid-modifying treatment for coronary heart disease risk reduction are receiving it.³ And of those on therapy, just half of patients actually achieve their cholesterol goals.⁴ This results in part from poor persistence by physicians in monitoring lipid levels and adjusting therapy accordingly, as . . . [Full Text of this Article]