Trends in the use of lipid-lowering medications at discharge in patients with acute myocardial infarction: 1998 to 2006

Background Compelling evidence demonstrates that certain lipid-lowering medications improve outcomes after acute myocardial infarction (AMI), but to what extent national utilization has increased in response to trials and guidelines has not been well studied. The objective of this study is to determine trends in the use of lipid-lowering medications at discharge for Methods A time trend analysis was conducted on treatment rates with lipid-lowering medications from 1998 to 2006 in 996,364 patients with AMI hospitalized in 1,669 hospitals participating in the National Registry of Myocardial Infarction (NRMI) 3, 4, and 5. Results Between 1998 and 2006, use of lipid-lowering medications at discharge increased from 29.3% to 83.8%, (relative risk [RR] 2.86, 95% CI 2.84-2.89, P < .0001). Increased use was observed in men (RR 2.71) and women (RR 3.17); age younger than 65 years (RR 2.32) and 65 years or older (RR 3.46); teaching (RR 2.47) and nonteaching hospitals (RR 2.96); and in all regions of the country. After adjusting for multiple other independent predictors, the temporal increase in use of lipid-lowering medications remained highly significant (RR 2.70, 95% CI 2.68-2.73, P < .0001). A significant upward jump in the rote of lipid-lowering medication use was observed most notably in month 72, corresponding to the publication on the PROVE-IT trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy trial). Conclusions Use of lipid-lowering medications in patients hospitalized with AMI has increased substantially in the United States in the past 8 years. The increase in the lipid-lowering medication use was possibly accelerated by certain randomized clinical trial evidence demonstrating improved outcomes in this high-risk population. (Am Heart J 2009;157:185-94.e2.)