Less than one-third of people with a history of coronary heart disease are taking lipid-lowering drugs and total cholesterol is reduced to target levels in only one in eight eligible patients, say public health researchers.
Dr Paola Primatesta (clinical lecturer, department of epidemiology and public health, Royal Free and University College medical school, London) and colleagues used data from a 1998 national health survey in England to evaluate lipid concentrations in adults and to see how many adults were receiving lipid-lowering drugs.
Of the 10,569 participants in the survey, 7,133 (67.5 per cent) had a total cholesterol concentration of 5mmol/L or more and 237 (2.2 per cent) reported taking lipid lowering drugs.
Of adults with a history of coronary heart disease who were eligible for treatment with lipid lowering drugs, only 30 per cent were receiving the drugs, the researchers say (British Medical Journal 2000;321:1322).
Dr Primatesta and colleagues say that, given the benefits of lowering lipids, they find it hard to understand why treatment rates are so low but add that the rate of treatment is increasing. They express the hope that the national service framework for coronary heart disease will allow the benefits of treatment in preventing heart disease to be realised.
Dr David Monkman (general practitioner, East Barnet health centre) speculates about the reasons for the inertia in prescribing of lipid lowering drugs in an accompanying leading article (ibid, p1299). Cost considerations have limited the use of these drugs to those patients at highest risk and cholesterol is only tested when additional risk factors are present, he says. In addition, concerns over the safety of lipid lowering drugs have contributed to the lack of prescribing and a tendency to use doses that are too low.
He says that a proactive approach, in which patients are actively sought out, is needed if the targets laid out in the national service framework are to be met.