Doctors Say Cholesterol-Lowering Drugs Aren't Prescribed Enough
March 08, 1999 4:38 PM
By Raymond Hennessey, Staff Reporter
NEW ORLEANS -(Dow Jones)- Despite a growing body of evidence that
lowering cholesterol helps prevent major heart disease, use of
cholesterol-lowering drugs remains low, doctors said.
Speaking at the American College of Cardiology Scientific Sessions on
Monday, Dr. James Froehlich of the University of Michigan Medical
Center said the use of the so-called statin drugs is improving, but is still
low.
The drugs are made and sold by pharmaceutical giants Pfizer Inc. (PFE),
Merck & Co. (MRK) and Warner-Lambert Co. (WLA).
In a survey of doctor visits tracked by Froehlich from 1990 to 1996, just
13% of patients diagnosed with cardiac disease were given some sort of
cholesterol-lowering drug.
There also were differences based on race, gender and the type of doctor
visited.
White men seen by cardiologists instead of primary care physicians
were the most likely to be prescribed a statin drug and the rates were
nearly double those of black patients.
Cardiologists were 40% more likely to prescribe the drugs than other
doctors, and women were between 20% and 25% less likely to get them
than men.
During the years studied, there was an increase in the number of
prescriptions, but "these numbers still fall below what we believe are
appropriate for patients with heart disease," Froehlich said.
Part of the problem may be that there is more focus on developing new
technologies to treat heart disease rather than finding ways to prevent it,
Froehlich said.
"If we simply stopped developing new treatment and simply applied what
we know about heart disease, we could have a significant impact," he
said.
The blame for the underuse of statin drugs doesn't just fall on doctors,
said Dr. Richard Pasternak, of Massachusetts General Hospital in
Boston. Patients often don't take preventive measures, like exercise or
lowering cholesterol, or they may not have access to affordable
treatment, he said.
In addition, the current health-care system rewards doctors for treating
diseases, not preventing them, both Pasternak and Froehlich said.
Studies have shown that statins help reduce levels of low-density
lipoprotein, or LDL, cholesterol, the so-called bad cholesterol. In turn,
many studies have shown that lowering LDL levels lowers the risk of
heart disease. But many studies show that only about one in five eligible
patients get the drugs.
Meanwhile, evidence of the effectiveness of statin drugs continues to
grow.
On Monday, Dr. Antonio Gotto Jr., dean of the Weill Medical College of
Cornell University, released more data showing that, even among those
patients not classified as having dangerous levels of LDL, use of a statins
helps reduce the risk of heart disease.
Patients with average LDL who were given a statin, in this case Merck's
Mevacor, showed a 40% reduction of risk for a heart attack and a 33%
reduction in the need for angioplasty of coronary bypass surgery, Gotto
said.
Of the patients studied, only 17% would have been considered eligible for
statins, but there was an equal benefit for patients regardless of their LDL
levels, he said.
Gotto said he was unable to find a threshold level where cholesterol
lowering would no longer be effective. Some previous studies have shown
that patients can only reduce their LDLs by so much before it no longer
reduces the risk factor.
But Gotto said he also found that LDL levels may not be the best
predictor of heart disease. Rather, individual proteins that make up both
LDL and high-density lipoprotein, or HDL, were probably better indicators.
The ratio of the proteins - apoliprotein B in LDL and apoliprotein B1 in
HDL - was a better indication of the risk of heart disease.
While there are a number of statins on the market, such as the
Warner-Lambert and Pfizer combination for Lipitor and Merck's Zocor,
what specific drug is prescribed really doesn't matter since the whole
class of drugs has shown a benefit, the doctors said.
In fact, while each drug has its own individual properties, the differences
are of "vanishing importance" compared with the need for the entire class
of statins to be used more, Froehlich said.
Raymond Hennessey: (201) 938-5240;
raymond.hennessey@cor.dowjones.com
Copyright (c) 1999 Dow Jones & Company, Inc.
All Rights Reserved.
- - 01 29 PM EST 03-08-99
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