Patients who begin therapy with a cholesterol-lowering drug in the hospital have better long-term compliance than patients who initiate use at home, according to an article in the November 24th issue of the Archives of Internal Medicine.

Despite data demonstrating the health benefits of these agents, they remain underused in actual practice, according to information in the article. In the current work, American investigators studied whether initiation as an inpatient rather than an outpatient had any effect on long-term adherence to the drug regimen.

Researchers used data from 69 centers in the United States and Canada that had participated in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial. The EPILOG trial enrolled patients hospitalized for treatment for heart disease and randomized them to placebo or lipid-lowering drugs. All patients were older than 21 years and were not taking lipid-lowering drugs when hospitalized. Of the total of 1,126 patients, 175 had started active drug therapy before leaving the hospital and 1,951 were discharged without having started therapy.

At 6 months, 134 people (77 percent) who had started drug therapy in the hospital were still taking the drug. In contrast, 494 people (25 percent) whose doctor prescribed the medication after discharge were still taking their medicine.

"We found that initiation of lipid-lowering agents before discharge was the most important independent predictor of their use at follow-up," the authors wrote. "In fact, patients in whom lipid-lowering therapy was initiated before discharge were nearly 3 times as likely to be taking these agents 6 months later."

The researchers concluded, "Our findings suggest that inpatient initiation of lipid-lowering therapy for the secondary prevention of coronary disease is an effective strategy to enhance subsequent use. Other modifiable factors that influence the long-term use of these agents must be identified if we are to bridge the gap between the current evidence base and practice of preventive medicine."