Coronary heart disease in the statin and aspirin era: Are results of clinical trials being put into practice?

Background: We studied the impact of recent advances in coronary prevention by assessing cardiovascular risk factors and their management in 98% of patients admitted to a coronary care unit with acute myocardial infarction (AMI) between January and December 1998 [177 patients, mean age 66±1 (S.E.M.) years, 114 males]. Methods and results: Sixty-two patients had a history of coronary heart disease (CHD). One in four of them was still smoking and 27% had a recorded history of hyperlipidaemia. Only 12 patients with known CHD (19%) were on lipid-lowering treatment. Total cholesterol was above 5 mmol/l in 98/168 (58%) of the patients and LDL-cholesterol was above 3 mmol/l in 91/148 (62%) of the patients. Twenty-eight patients (16%) died during the hospital stay (age 74±2 years). Of 149 patients discharged from hospital, 101 (68%) were treated with a statin, including 85% of the patients with a total fasting cholesterol on admission above 5 mmol/l and 91% with LDL-cholesterol on admission above 3 mmol/l. Sixty-three percent of the patients on a statin were on a dose below that shown in clinical trials to reduce cardiovascular events. Conclusions: Unrecognised and ineffectively treated cardiovascular risk factors were common among patients with documented CHD who were admitted with AMI. Our study provides important background for the implementation of guidelines for the prevention of CHD.