Effective strategies for long-term statin use.

Long-term statin use achieves a significant reduction in mortality (24% to 42%) for patients with coronary artery disease (CAD) that is equal to or greater than that seen with other secondary prevention medications, including aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. In patients with diabetes, the reduction in mortality exceeds that seen with tight glycemic control or any other treatment for diabetes. Several studies have found that almost all patients with atherosclerosis are considered candidates for statin treatment. The scientific evidence needed to revise the national guidelines has been provided by showing that initiation of statins before hospital discharge results in (1). a marked increase in long-term treatment rates, (2). improved long-term patient compliance, (3). more patients reaching levels of low-density lipoprotein (LDL) cholesterol <100 mg/dL, and (4). improved clinical outcome. Nonetheless, many studies in a variety of clinical settings have demonstrated that, regardless of the health care delivery system, an unacceptable number of patients with atherosclerosis are left untreated or undertreated with statin therapy. Applying hospital-based systems has been demonstrated to address the problems of underuse. The national guidelines now recommend that, in addition to diet and exercise counseling, lipid-lowering medications be initiated before hospital discharge for patients diagnosed with cardiovascular disease. Optimal use of statins and other cardioprotective medications in high-risk patients could save >83000 lives per year in the United States.