Changing trends (1986–2003) in the use of lipid lowering medication in patients hospitalized with acute myocardial infarction: A community-based perspective

OBJECTIVES: The objectives of this community-wide observational study were to describe nearly two decade long (1986-2003) trends in the use of lipid lowering therapy in patients hospitalized with acute myocardial infarction (AMI) and clinical and demographic factors associated with underutilization of this treatment regimen. METHODS: A total of 9429 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003 comprised the study population. Hospital medical records were reviewed to ascertain the prescribing of lipid lowering agents during hospitalization for AMI. RESULTS: The mean age of the study sample was 70 years, 58% were men, and the average total and LDL serum cholesterol levels were 203 and 114 mg/dL, respectively. There was a marked increase in the use of lipid lowering therapy in greater Worcester residents hospitalized with AMI between 1986 (<1%) and 2003 (76%). Increasing use of lipid lowering medication was observed both with regards to the maintenance of this therapy in patients who were already on this treatment regimen and in the new initiation of lipid lowering medication in patients who had not been previously treated with this therapy. Several patient demographic and clinical factors, including advanced age and an initial AMI, were associated with the failure to be prescribed lipid lowering therapy during hospitalization for AMI. CONCLUSIONS: The results of this study suggest encouraging increases over time in the use of lipid lowering therapy in patients hospitalized with AMI. Despite these encouraging trends, several high-risk patient groups remain suboptimally treated.