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High risk heart patients least likely to receive life saving medications


The sickest heart disease patients are the ones least likely to receive drugs that can prevent them from having future heart attacks or dying, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.

Researchers studied over 396,000 elderly Ontarians with heart disease to determine if those patients that should have been receiving statin drug therapy actually did. Statins have been shown to be one of the best classes of drugs in preventing future cardiac events and death.


  • Only 19% of patients were prescribed statins.
  • The probability of statin prescription was lowest in patients with the highest risk of future cardiac events and death, and highest in those with the lowest risk of future events (probability of statin prescription drug therapy was 38% for low-risk patients, 27% for intermediate-risk patients, and 23% for high-risk patients).
  • The likelihood of statin prescription was 6% lower for each year of increase in age and each 1% increase in risk (predicted risk of death in three-years).

“The use of statins in Ontario reflects a physician ‘treatment-risk paradox’,” said senior author and ICES scientist Dr. David Alter. “Not only are we under treating all patients with evidence-based therapies like statins, often we are treating the wrong patients, emphasizing lower risk patients over those at higher risk.

“There may be several reasons for this ‘treatment-risk paradox’,” said lead author and ICES research fellow Dr. Dennis Ko. “Physicians may be under the misconception that these drugs will cause more harm than benefit in high risk patients. They may also assume their patients will not adhere to the drug therapy, especially if they are taking medications for other conditions. As well, in patients with multiple medical conditions, physicians may be less attentive to cardiovascular prevention.”

In order for the population to experience the maximum survival benefits of proven cardiovascular drug therapies, such as statins, the study authors stress that physicians need to appropriately attune their prescribing behaviours to the risk profiles of their patients. As well, higher risk patients must be made aware of the benefits of additional drug therapy in preventing future events and reducing the risk of death.

The study, “Lipid-lowering therapy with statins in high-risk elderly patients”, is in the Apr. 21, 2004 issue of the Journal of the American Medical Association (JAMA).

Author affiliations: Dr. Dennis Ko, Dr. Muhammad Mamdani, and Dr. David Alter – ICES (Institute for Clinical Evaluative Sciences); Dr. Dennis Ko and Dr. David Alter – Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
  • (416) 480-4055 ext. 3602 or cell (416) 432-8143


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