The human and economic costs of undertreatment with statins

Abstract

Several guidelines for the prevention and management of coronary heart disease (CHD) have been published. These generally recommend lipid-lowering therapy in patients with and without established CHD on the basis of their low-density lipoprotein cholesterol (LDL-C) levels and, for cases without established CHD, their risk-factor profile. Statins are the preferred lipid-lowering agent for the prevention of CHD because of overwhelming clinical trial evidence that they can significantly reduce the occurrence of CHD mortality and morbidity. Despite the guidelines, only approximately one-third of eligible patients receive lipid-lowering therapy in clinical practice--even for secondary prevention of CHD--and many treated patients fail to achieve their target LDL-C levels. This underuse must affect patients' clinical outcome and quality of life and has economic consequences for society. Reasons for the underuse may include physicians' and patients' attitudes and knowledge, and the perceptions of physicians and healthcare purchasers about economic factors. Health economic evaluations have confirmed that secondary prevention with statins is cost-effective, and that primary prevention is also reasonably cost-effective, depending on the absolute CHD risks in targeted individuals. Newer statins with greater efficacy in reducing LDL-C levels may allow patients to reach target levels more quickly and without the need for dose titration, thus improving clinical outcomes and being more cost-effective in the long term. This proposition should be testedin future clinical trials.