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Patients with acute coronary syndrome should start a statin while still in hospital
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  1. C G Isles
  1. Correspondence to:
    Dr Chris Isles, Medical Unit, Dumfries & Galloway Royal Infirmary, Dumfries DG1 4AP, UK;
    c.isles{at}dgri.scot.nhs.uk

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Despite well documented clinical benefit of statins in patients with coronary heart disease, there remains a significant “treatment gap” between those patients in whom treatment is indicated and those who actually receive it

Two papers in this issue of Heart address the low uptake of statins. The first, by Reid and colleagues, is a cross sectional analysis of data from the Health Survey for England 1998 of 760 adults with coronary heart disease which shows that the elderly (over 65 years), smokers, and patients with angina are less likely to be given statins than younger patients, non-smokers, and those with previous myocardial infarction.1 The second paper, by Steg and associates, is an analysis of 3092 patients admitted with acute coronary syndromes to 390 hospitals across Europe which shows, inter alia, prescription rates for statins at discharge were higher among patients undergoing coronary angiography or percutaneous intervention than in patients treated conservatively.2 In the first study, which was conducted in primary care, only 25.4% of eligible subjects were taking lipid lowering medication. More lipid lowering drugs were prescribed in the second study, which was hospital based, but still only 42.9% of patients were treated appropriately. The authors of both studies concluded that we discriminate for or against certain patient characteristics when we prescribe statins. An equally clear message from both papers is that despite well documented clinical benefit of statins in patients with coronary …

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    BMJ Publishing Group Ltd and British Cardiovascular Society