麻豆传媒

Getting patients started on high-intensity statins after hospital discharge for an MI is becoming more popular, a study suggested, although the authors said more people could be on statins.

Among patients with commercial health insurance, the proportion of those who got a high-intensity statin prescription filled for secondary prevention after leaving the hospital was .

Similarly, that figure rose from 24.8% to 57.5% among Medicare patients, according to Robert S. Rosenson, MD, of Mount Sinai Heart in New York City, and colleagues.

"Despite this favorable trend, a substantial percentage of patients filled low- or moderate-intensity statin prescriptions following hospital discharge for MI in 2014. The present study highlights the need to continue efforts to increase high-intensity statin use following hospital discharge for MI," they wrote in the Journal of the American College of Cardiology.

Rosensen's group counted atorvastatin (Lipitor) and rosuvastatin (Crestor) as high-intensity statins. Atorvastatin was the only one of the two that showed an increase in popularity over the years; rosuvastatin actually lost prescription fills.

The reason, according to the authors: "In November 2011, the patent for atorvastatin expired, making this agent available in a generic version to some pharmacy benefit plans. By mid-2012, exclusive manufacturing rights expired, resulting in more widespread and less costly generic formulations of atorvastatin becoming available."

After multivariable adjustment, those more likely to get a high-intensity statin during the study period were men; those that also filled scripts for beta blockers and antiplatelets; and patients attending cardiac rehabilitation within 30 days of discharge.

Patients who got low- or moderate-intensity statins were more likely to get up-titrated to a stronger dose over time as well, their odds growing from 6.1% to 12.9% among commercial insurance patients and 3.7% to 9.2% among Medicare beneficiaries.

Besides the availability of generic atorvastatin, the authors pointed to the 2011 black-box warning by the FDA cautioning against 80 mg simvastatin (Zocor) as a potential reason for its decline, as well as American secondary prevention and cholesterol guidelines released in 2011 and 2013.

Their study took claims data from patients, ages 19-64, with commercial health insurance (n=42,893) and ages 66-75 covered under Medicare (n=75,096).

"An encouraging aspect of these new data for use of high-intensity statin from [the authors] suggests that clinicians do understand that not all high-intensity statin regimens have equivalent efficacy and safety," commented Neil J. Stone, MD, of Northwestern University Feinberg School of Medicine in Chicago.

In an , he found it "unclear why 80-mg simvastatin is still available." As for getting 100% of patients on strong statins, however, he placed great importance on clinical judgment on a case-by-case basis.