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Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India

Authors Sharma KK, Gupta R, Agrawal A, Roy S, Kasliwal A, Bana A, Tongia RK, Deedwania PC

Published 20 November 2009 Volume 2009:5 Pages 1007—1014


Review by Single anonymous peer review

Peer reviewer comments 2

Krishna K Sharma1, Rajeev Gupta2, Aachu Agrawal3, Sanjeeb Roy2, Atul Kasliwal2, Ajeet Bana2, Ravindra K Tongia2, Prakash C Deedwania4

1Department of Pharmacy, LBS College of Pharmacy, Jaipur, India; 2Departments of Medicine, Cardiology and Cardiac Surgery, Fortis Escorts Hospital, Jaipur, India; 3Department of Home Science, University of Rajasthan, Jaipur, India; 4Department of Cardiology, University of California San Francisco-VA Health System, Fresno, CA, USA

Objective: To determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.

Methods: Physicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.

Results: We evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P
 < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.

Conclusions: There is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.

Keywords: statins, coronary heart disease, aspirin, beta blockers, angiotensin-converting enzyme inhibitor

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