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previous recommendations. One study reviewed treatments at
discharge and after 1 year in 6748 patients with a myocardial
infarction and found that only 1 in 3 patients were prescribed
an appropriate intensity statin and only 25% of patients were
prescribed an increase in dosage after discharge (9). The incidence of statin myopathy and transaminitis has been reported
at rates of 1.5% to 5.0% (10) and 2% to 3%, respectively (11).
Although side eﬀects may be a barrier to statin adherence, a
number of physicians clearly are underprescribing statins at
the correct dose. We would advise increasing the dose during
patient follow-up; if a patient cannot tolerate a statin due to
side eﬀects, dose reductions or alternative nonstatin therapies
should be considered rather than no treatment.
Our study had multiple limitations, including the small
sample size and single center design. Evaluation of patients with
reduced ejection fraction may have been beneﬁcial to assess appropriateness of noncompliance rates with ACEI therapy; however, the 2014 guidelines suggest there is evidence that ACEIs
may be reasonable in all patients with cardiac or vascular disease
(class IIb, level B) (12). The external validity of the results may
be limited, and caution must be taken when generalizing the
ﬁndings of our study. However, in order to better generalize the
results, it is crucial to conduct more studies, including those
in hospitals from areas all over the US. Furthermore, to meet
benchmarks of quality care, management can be compared between diﬀerent institutions.
1.

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Baylor University Medical Center Proceedings

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