Another treatment gap: Restarting secondary prevention medications: The Women's Health Initiative

• Published in: Journal of clinical lipidology 2010-01, Vol.4 (1), p.36-45
• Main Authors: Robinson, Jennifer G., MD, MPH, Wallace, Robert, MD, Safford, Monika M., MD, Pettinger, Mary, MS, Cochrane, Barbara, PhD, RN, Ko, Marcia G., MD, O'Sullivan, Mary Jo, MD, Masaki, Kamal, MD, Petrovich, Helen, MD
• Format: Article
• Language: English
• Subjects: Adherence; Adrenergic beta-Antagonists - therapeutic use; Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Aspirin - therapeutic use; Cardiovascular; Cohort Studies; Coronary Disease - drug therapy; Coronary Disease - prevention & control; Coronary heart disease; Evidence-Based Medicine; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Middle Aged; Secondary prevention; Secondary Prevention - methods; Statins; Women
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2009.12.006

Background Women's long-term patterns of evidence-based preventive medication use after a diagnosis of coronary heart disease have not been sufficiently studied. Methods Postmenopausal women ages 50 to 79 years were eligible for randomization in the Women's Health Initiative's hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis ( n = 2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6, and 9. Results Use at the first Women's Health Initiative visit after a coronary heart disease diagnosis increased over time for statins (49% to 72%; P < .0001), beta-blockers (49% to 62%; P = .003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs; 26%-43%; P  < .0001). Aspirin use remained stable at 76% ( P = .09). Once women reported using a statin, aspirin, or beta-blocker, 84% to 89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28%, respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively. Conclusions Efforts to improve secondary prevention medication use should target both drug initiation and restarting drugs in patients who have discontinued them.