Wysowski D K, Kennedy D L, Gross T P
Division of Epidemiology and Surveillance, Food and Drug Administration, Rockville, Md.
JAMA. 1990 Apr 25;263(16):2185-8.
Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in outpatient use of cholesterol-lowering drugs in the United States from 1978 through 1988. Retail pharmacies dispensed an estimated 4.4 million prescriptions for cholesterol-lowering drugs in 1978. This declined to 2.6 million in 1983 and increased dramatically to nearly 13 million in 1988. This fivefold increase between 1983 and 1988 was accounted for primarily by the introduction and use of two new drugs, gemfibrozil and lovastatin, and, to a lesser extent, by the increasing use of some older drugs. In 1988, after 1 full year of marketing, lovastatin was the leading cholesterol-lowering drug, followed closely by gemfibrozil; both drugs are currently considered second-line agents. Clofibrate and dextrothyroxine, drugs that ranked first and second in 1978, declined to ranks of sixth and eighth out of eight in 1988. Cholestyramine, gemfibrozil, and lovastatin accounted for about 75% of all lipid-lowering prescriptions in 1988. From 1978 through 1988, an average 54% of individuals using cholesterol-lowering drugs were 60 years of age or older. The 13 million prescriptions for cholesterol-lowering drugs in 1988 represent a maximum estimate of 13 million treated individuals. This number compares with the 60 million Americans with high cholesterol levels who are candidates for dietary advice, and, if cholesterol levels do not improve, for combined diet and drug intervention.
利用两个药品市场研究数据库（即国家处方审计数据库和国家疾病与治疗指数数据库）的数据，对1978年至1988年美国门诊使用降胆固醇药物的趋势进行了研究。1978年，零售药店开出了约440万份降胆固醇药物处方。到1983年，这一数字降至260万，而到1988年则大幅增至近1300万。1983年至1988年的这五倍增长主要是由于两种新药吉非贝齐和洛伐他汀的推出和使用，在较小程度上也归因于一些老药使用的增加。1988年，洛伐他汀在上市整整一年后成为领先的降胆固醇药物，紧随其后的是吉非贝齐；目前这两种药物都被视为二线药物。氯贝丁酯和右旋甲状腺素在1978年分别排名第一和第二，到1988年在八种药物中降至第六和第八位。1988年，考来烯胺、吉非贝齐和洛伐他汀占所有降脂处方的约75%。1978年至1988年期间，使用降胆固醇药物的个体中平均54%为60岁及以上。1988年开出的1300万份降胆固醇药物处方最多代表1300万接受治疗的个体。这个数字与6000万胆固醇水平高、适合接受饮食建议的美国人相比，如果胆固醇水平没有改善，则适合进行饮食和药物联合干预。
