Use of cholesterol-lowering medications in the United States from 1991 to 1997

Abstract

The benefits of cholesterol-lowering medication in hypercholesterolemic patients was first suggested by the long-term follow-up of the Coronary Drug Project, which studied the use of niacin in men with previous myocardial infarction (1). Since that study, several secondary prevention trials using different 3-hydroxy-3methylglutaryl coenzyme A reductase inhibitors (statins) have found even greater benefit in these patients (2,3), including men and women with average serum cholesterol levels (4). Benefits have also been shown in a primary prevention trial among men with hypercholesterolemia (5). In 1988, the National Cholesterol Education Program (NCEP) issued recommendations for the detection and control of hypercholesterolemia (6). Subsequently, there has been increased use of cholesterol-lowering medications (7,8), although several studies indicate that these drugs are underutilized (9 –11). Several investigators have studied the patterns of use of cholesterol-lowering medications by geographic region, physician specialty, and type of health care insurance (9,11), and there have also been studies of adherence and adequacy of dosage (12–14). None of these reports evaluated a national sample to determine whether the patterns of cholesterol-lowering therapy have changed with time, in terms of class of medication or use of specific medications. To provide information on these questions, we examined national trends in prescribing patterns for cholesterol-lowering medications from 1991 through 1997.