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Patients starting cholesterol-lowering drugs in hospital take meds longer

The JAMA Network Journals

CHICAGO - Starting patients on cholesterol-lowering drugs in the hospital instead of after they go home may increase the likelihood that they will continue taking their medications longer, according to an article in the November 24 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Despite data demonstrating the health benefits of lipid-lowering drugs (drugs that lower cholesterol levels) in patients with heart disease, these medicines remain underused, according to information in the article. Because lipid-lowering agents can improve cardiovascular health, strategies to increase their use are needed, the article states. Lipid-lowering therapy can be started when a patient is either in the hospital, or in an outpatient setting; it has been suggested that initiating therapy in the hospital may increase the probability that the patient adheres to the regimen for longer periods of time than if initiated outside the hospital.

Steven E. Nissen, M.D., of the Cleveland Clinic Foundation, and colleagues examined the relationship between when lipid-lowering therapy is initiated (during a hospital stay, or in an outpatient setting) and its long-term use.

The researchers used data from patients at 69 centers from the United States and Canada that participated in the Evaluation in PTCA to Improve Long-term Outcome With Abcix-imab GP IIb/IIIa Blockade (EPILOG) trial. The EPILOG trail involved patients hospitalized for treatment for heart disease who were randomized to receive placebo or lipid-lowering drugs. The patients were older than 21 years and were not taking lipid-lowering drugs when hospitalized. One hundred and seventy-five patients were discharged taking lipid-lowering therapy and 1,951 were discharged without lipid-lowering therapy.

The researchers found that after six months, 134 patients (77 percent) who started taking lipid-lowering agents before hospital discharge continued taking therapy compared with 494 (25 percent) of those discharged without lipid-lowering therapy, and who had these drugs prescribed by their doctors later.

"We found that initiation of lipid-lowering agents before discharge was the most important independent predictor of their use at follow-up," the authors write. "In fact, patients in whom lipid-lowering therapy was initiated before discharge were nearly three times as likely to be taking these agents six months later."

The researchers conclude: "Our findings suggest that inpatient initiation of lipid-lowering therapy for the secondary prevention of coronary disease is an effective strategy to enhance subsequent use. Other modifiable factors that influence the long-term use of these agents must be identified if we are to bridge the gap between the current evidence base and practice of preventive medicine."

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(Arch Intern Med. 2003;163:2576-2582. Available post-embargo at archinternmed.com)

Editor's Note: The EPILOG trial was funded by Centocor, Malvern, Pa., and Eli Lilly and Co., Indianapolis, Ind.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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