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Are high coronary risk patients missing out on lipid-lowering drugs in Australia?

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Lipid-lowering drugs (LLD), especially statins, are of proven benefit in preventing future coronary heart disease (CHD), both recurrent events and first events in those at high coronary risk.13 The Organisation for Economic Co-operation and Development (OECD) noted that consumption of LLD in Australia in 2011 was the highest of 23 countries reported.4 The rate was 50% higher than the OECD average and had risen more than 300% since 2000.4

Given this high level of use, it is important to know whether LLD are being prescribed for the correct mix of patients. The Australian ACACIA registry reported that statins were prescribed for 75%–89% of patients with acute coronary syndrome in 2005–2007, with the rate varying depending on the clinical presentation.5 Similarly, a large European survey of patients with CHD reported that 89% had been prescribed statins in 2006–2007,6 while a companion survey in the general practice setting found that 47% of “high-risk” patients with hypercholesterolaemia had been prescribed statins.7

The AusHEART study, an Australian general practice survey of risk factor perception and management in 2008, found that 50% of patients…