European Journal of Internal Medicine 11 (2000) 309–316 www.elsevier.com / locate / ejim Original article Systematic, immediate in-hospital initiation of lipid-lowering drugs during acute coronary events improves lipid control a a b c a Alain Nordmann , Luc Blattmann , Augusto Gallino , Reza Khetari , Benedict Martina , d b e a, * ¨ Peter Muller , Giuseppe Plebani , Hanspeter Schmid , Edouard Battegay a Medical Outpatient Division, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland b Ospedale Regionale San Giovanni, 6500 Bellinzona 4, Switzerland c ˆ ˆ Hopital de la Ville aux Cadolles, Rue des Cadolles 4, 2000 Neuchatel, Switzerland d ¨ Ratisches Kantons- und Regionalspital Chur, 7000 Chur, Switzerland e Thurgauisches Kantonsspital Frauenfeld, 8500 Frauenfeld, Switzerland Received 10 January 2000; received in revised form 26 June 2000; accepted 29 June 2000 Abstract Background: Patients who have had a coronary heart attack often go completely untreated for hypercholesterolemia. We investigated whether immediate initiation of lipid-lowering drugs during hospitalization for acute coronary events increases the proportion of correctly treated patients compared to referred treatment as recommended by current guidelines. Methods: This prospective, multicenter study randomized 57 hypercholesterolemic patients hospitalized for acute coronary events to immediate in-hospital initiation or to referred initiation of lipid-lowering drugs by primary care physicians 3 months after unsuccessful nutritional intervention. Results: After 6 months, 53 patients were available for follow-up. More patients in the immediate initiation group (26 / 30 patients, 87%) were treated with lipid-lowering drugs than in the referred initiation-group (13 / 23 patients, 57%, P50.03). Twenty-seven patients (87%) in the immediate initiation group versus 17 patients (65%) in the referred initiation group had a 10% or greater decrease in total cholesterol or a 15% or greater decrease in LDL-cholesterol (P50.18). Although statistically not significant, there was a trend to improved lipid values in the immediate initiation group compared to the referred initiation group (TC, 221.1 vs. 213.8% ( P50.08); LDL-C, 228.2 vs. 218.9% ( P50.13); HDL-C, 110.8 vs. 15% ( P50.44); TC / HDL-C ratio, 224.7 vs. 215.1% (P50.22)), and the LDL-C / HDL-C ratio was 234.1 vs. 219.1% ( P50.04, P5NS after Bonferroni correction). Conclusion: The immediate initiation of lipid-lowering drugs in hy- percholesterolemic patients hospitalized for acute coronary events increases the rate of correctly treated patients and has the potential to improve lipid control.  2000 Elsevier Science B.V. All rights reserved. Keywords: Hypercholesterolemia; Coronary disease; Guidelines; Myocardial infarction; Hydroxymethylglutaryl-CoA reductase inhibitors 1. Introduction of the Task Force of the European Society of Cardiology, European Atherosclerosis Society, and European Society Lipid-lowering medication significantly reduces car- of Hypertension often call for an initial dietary intervention diovascular and overall mortality in patients with coronary before starting lipid-lowering therapy [6–9]. As a result, heart disease and with elevated [1–3] or average [4,5] the task of initiating lipid-lowering therapy is often cholesterol levels. Current guidelines addressing the man- referred to the primary care physician. Primary care agement of hyperlipidemia, such as the recommendations physicians, however, may be somewhat reluctant to initiate lipid-lowering therapy due to a lack of specific knowledge, the patient’s refusal to modify a drug regimen instituted *Corresponding author. Tel.: 141-61-265-5005; fax: 141-61-265- upon hospital discharge, or pressure from health insurance 5055. E-mail address: ebattegay@uhbs.ch (E. Battegay). companies. 0953-6205 / 00 / $ – see front matter  2000 Elsevier Science B.V. All rights reserved. PII: S0953-6205(00)00110-2