After heart attacks, most don’t get enough statins

(Reuters Health) – In the U.S., less than a third of older heart “event” patients being discharged from the hospital get the recommended high-intensity statins, according to a new study that looked at prescriptions filled.

National guidelines from the American College of Cardiology and American Heart Association say the majority of patients should be on a high-dose statin following a serious heart disease-related event like heart attack or bypass surgery.

“It appears that there’s tremendous reticence in prescription of statin therapy,” said lead author Dr. Robert S. Rosenson of the Icahn School of Medicine at Mount Sinai in New York.

“Whatever the dose of statin people were taking when they came to the hospital was the dose they went out on, the acute event didn’t change it,” he told Reuters Health. “This is very disappointing.”

The authors studied a random sample of Medicare beneficiaries ages 65 to 74 who filled a statin prescription after having a heart attack or bypass surgery between 2007 and 2009.

Of more than 8,000 people who filled a statin prescription after one of these events, only 27 percent of the first post-discharge prescriptions were for “high-intensity” statins, such as 40 to 80 milligrams of atorvastatin (Lipitor) or 80 milligrams of simvastatin (Zocor).

Less than 25 percent of people who were not taking a statin before their hospitalization filled a high-intensity statin prescription on their release, and less than 10 percent of those who had been taking a low-intensity statin switched to a high-intensity one.

About 80 percent of people who had already been taking high-intensity statins filled another such prescription immediately upon leaving the hospital, according to the results in the Journal of the American College of Cardiology.

Of the patients whose first post-discharge prescription fill was for a low-intensity statin, less than 12 percent switched to a high-intensity dosage within the following year.

“There’s a tremendous amount of confusion,” Rosenson said. Though the clinical guidelines, which are supported by rigorous studies and high quality results, indicate that high dose statins are better than low dose statins after an acute cardiac event, many doctors appear not to be following them.

High intensity statins have been linked to better health outcomes in the short and long term for these patients, he said.

“It could be that either the doctors are not aware of the guidelines that high intensity therapy is proven to be better, or more likely they are focusing on the (low-density lipoprotein) cholesterol level,” he said.

There has been confusion on whether or not to dose statins based on LDL cholesterol readings for some patients, but for those who have suffered an acute cardiac event, a high dose is better, he said.

“If statins are fairly safe and highly effective agents particularly for these types of patients, yet only about 50 to 60 percent of these patients are on what has been recommended and proved, why is that?” asked Dr. Prakash Deedwania of the University of California San Francisco School of Medicine in Fresno who wrote an editorial accompanying the new results.

Side effects from statins are rare, he noted, and cost of the drugs – which are mostly generic, inexpensive, and covered by insurance including Medicare – should not be an issue. There is some risk of developing what is know as “chemical diabetes,” but the benefits of the drugs far outweigh this risk, Deedwania told Reuters Health.

“The benefit is 10-fold greater than any sort of harm,” he said.

When doctors know that an oversight body is going to be looking at their prescribing data, they are more likely to follow guidelines, he said.

“We should be doing this without anyone looking, but unfortunately it doesn’t work like that,” Deedwania said.

Though the authors focus on doctors likely not prescribing the recommended statin dose, there could be confusion or reluctance on the patient side as well, he said.

Much like blood pressure medication, statins don’t provide immediate symptom relief while they are acting in the body. Since patients don’t feel a difference when they take the medication, they may not be motivated to continue taking it, he said.

“The burden is on us to educate our patients, tell them precisely in simple terms what are the benefits of statins,” Deedwania said.

In addition to reducing the risk of another heart attack and making a bypass graft more durable over time, statins reduce the risk of stroke, he said.

“That resonates really well,” Deedwania said. “Everybody wants to get extra benefits,”

SOURCE: bit.ly/1CQS8Tc JACC, online January 19, 2015.