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Many Who Should Use Statins Don't

Survey finds lack of access to medical care a big factor in trend

SATURDAY, April 25 (HealthDay News) -- Nearly half of the Americans who meet the criteria for taking cholesterol-lowering statins aren't taking the drug, a national survey indicates.

"There is a definite gap between medical evidence and practice," said Dr. Erica S. Spatz, an internist in the Yale University Robert Wood Johnson Medical Scholar Program. She was to report the finding Saturday at an American Heart Association meeting in Washington, D.C.

Spatz and her colleagues used data from the 2003-2004 National Health and Nutrition Examination Survey to identify 777 adults who met the criteria set by the National Cholesterol Education Program for statin therapy. Those criteria consider not only blood levels of LDL cholesterol, the "bad" kind found in artery-clogging plaques (in general, a reading below 100 milligrams per deciliter is recommended), but also other risk factors for cardiovascular disease, such as smoking, obesity and high blood pressure.

jUST 428 of those individuals were taking cholesterol-lowering drugs, the survey found. Overall, 44.9 percent of the people who met the criteria for cholesterol-lowering drug treatment were untreated, Spatz reported.

Major factors associated with being untreated were:

  • Being younger than 50 -- twice as likely to be untreated.
  • Not having health insurance -- more than twice as likely to be untreated.
  • Not having a source of regular medical care -- nearly four times as likely to be untreated.
  • Having untreated or undiagnosed diabetes -- more than six times as likely to be untreated.

People who reported being told they had high cholesterol and who had a history of heart disease were more likely to be taking the medications.

"The most interesting finding from our study is that lack of health insurance is certainly predictive," Spatz said. "The cost of medication is sometimes prohibitive."

But not having a regular source of medical care is an even more important indicator, she said.

The factors related to high cholesterol tend to be interlocking, Spatz said. "High blood cholesterol is associated with other co-morbidities, such as high blood pressure and diabetes," she said. "These people often are underdiagnosed for those conditions, which reinforces the need for access to medical care."

Even though a problem has been identified, "there is no simple solution to this," Spatz said. "We need to address the reasons why there is poor access to medical care for people with insurance."

The study shows the need for adherence to the guidelines for statin therapy, said Dr. Gregg Fonarow, a professor of medicine at the University of California, Los Angeles, and a spokesman for the American Heart Association.

"Those guidelines are based on randomized clinical trials which show that statin therapy lowers the risk of myocardial infarction [heart attack] and stroke for eligible patients," Fonarow said. "More needs to be done to implement the current guidelines."

Drug therapy is not the only measure to be taken against high cholesterol, he said. "Lifestyle modifications and medications are both appropriate measures," he said. "This is a very serious issue that requires much more attention and focused efforts."

More information

Learn what you need to know about high cholesterol from the National Cholesterol Education Program.

SOURCES: Erica S. Spatz, M.D., Robert Wood Johnson Medical Scholar, Yale University, New Haven, Conn.; Gregg Fonarow, M.D, professor, medicine, University of California, Los Angeles; April 25, 2009, presentation, American Heart Association 10th Scientific Forum on Care and Outcomes Research in Cardiovascular Disease and Stroke, Washington, D.C.

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