CARDIOVASCULAR MEDICINE Low prevalence of lipid lowering drug use in older men with established coronary heart disease

Objective: To determine the prevalence and correlates of lipid lowering drug use among older British men with established coronary heart disease (CHD). Design: Cross sectional survey within a cohort study (British regional heart study) carried out at 20 years of follow up in 1998–2000. Setting: General practices in 24 British towns. Participants: 3689 men aged 60–75 years (response rate 76%). Main outcome measures: Diagnoses of myocardial infarction and angina based on detailed review of general practice records. Lipid lowering drug use and blood cholesterol concentrations ascertained at 20 year follow up examination. Results: Among 286 men with definite myocardial infarction, 102 (36%) were taking a lipid lowering drug (93 (33%) a statin); among 360 men with definite angina without myocardial infarction, 84 (23%) were taking a lipid lowering drug (78 (21%) a statin). Most men with documented CHD who were not receiving a lipid lowering drug had a total cholesterol concentration of 5.0 mmol/l or more (87% of those with myocardial infarction, 82% with angina). Fewer than half of men with CHD receiving a statin had a total cholesterol concentration below 5.0 mmol/l (45% of those with myocardial infarction and 47% of those with angina). Only one third of the men taking a statin were receiving trial validated dosages. Among men with CHD, a history of revascularisation, more recent diagnosis, and younger age at diagnosis were associated with a higher probability of receiving lipid lowering drug treatment. Conclusion: Among patients with established CHD, the prevalence of lipid lowering drug use remains low and statin regimens suboptimal. Major improvements in secondary prevention are essential if the benefits of statins are to be realised.