Improving the Pathway From Cardiovascular Medication Prescribing to Longer-Term Adherence

edications are the cornerstone of the treatment and prevention of coronary heart disease.More than 40% of the decline in coronary heart disease mortality observed over the past decades has been attributed to the application of evidence-based drug therapies. 1To maximize the benefits that these drugs offer, a cascade of events from appropriate prescribing to longer-term adherence must be successfully performed.As with most multistep processes, lesions at numerous points on this pathway have been appreciated for many years. 2Although the efforts of professional societies 3 and credentialing bodies 4 have improved medication use in high-risk patients discharged from hospital, other guidelinerecommended therapies continue to be substantially underprescribed 4 and long-term adherence with these therapies remains suboptimal. 5 Articles see pp 228 and 236Two studies in this issue of Circulation: Cardiovascular Quality and Outcomes provide new and important data about these old issues.Nasir et al 6 studied the relationship between coronary artery calcium scores (CACS) and the use of lipid-lowering medication, antihypertensives, and aspirin in patients without known coronary artery disease.CACS results (and their interpretation) were provided to patients and the majority of their physicians.The investigators found that patients with higher CACS (especially Ͼ400) were more likely to be started on treatment.CACS scores were also associated with medication continuation, although the strength of this association was somewhat weaker.Although the relationship between CACS results and medication use is intriguing, the study's most important findings relate to the underuse of evidence-based therapies.At baseline, 15% of patients with LDL levels above National Cholesterol Education Program (NCEP) treatment thresholds were not receiving lipid-lowering therapy.More notable, 31% of patients eligible for blood pressure lowering based on Joint National Committee on Prevention, Detection, Evalua-