Assessing the Prevalence and Treatment of Severe Hypercholesterolemia

An analysis of the electronic health records (EHRs) of a multidisciplinary healthcare system identified gaps in the treatment of patients with primary severe hypercholesterolemia (SH), including the suboptimal use of high-intensity lipid therapy among primary care providers and specialists, according to a study published in the American Journal of Cardiology.

The researchers found that the use of statins and high-intensity statins was higher in patients with SH but still fell far below the recommended use according to current guidelines, especially for younger patients. “There remains a significant opportunity to improve the use of lipid-lowering therapy for this high-risk population,” reported the researchers.

Participants of the study were enrolled in a clinical query aimed at identifying every patient with low-density-lipoprotein cholesterol (LDL-C ≥ 190 mg/dL) documented in the EHR to assess SH prevalence, characteristics, and treatment. Records were identified as SH (group 1) if the maximum EHR-documented LDL-C or last estimated untreated LDL-C during the timeframe was ≥190 mg/dL. Records of subjects not meeting these criteria were placed in group 2.

Patient comorbidities, tobacco exposure, and prescribed lipid-lowering therapies were assessed. Comorbidities included coronary artery disease (CAD), diabetes type 1 (T1D) or type 2 (T2D), essential hypertension, congestive heart failure, and obesity. Different lipid-lowering therapies included statins, ezetimibe, and PCSK9 inhibitors.

A total of 289,299 records were screened; after exclusion criteria, 265,220 records were used for the analysis, with 19,695 having LDL-C ≥190 mg/dl (7.4%). Individuals in group 1 were generally 3 to 4 years older than those in group 2 and had a slightly higher prevalence of CAD (5.8% vs 2.7%). Individuals in group 1 had a slightly higher prevalence of obesity and diabetes than those in group 2 but a lower body mass index. More individuals in group 1 were exposed to smoking than group 2. Group 1 had a higher prevalence of hypertension and higher mean blood pressure, systolic blood pressure, and diastolic blood pressure than group 2.

Total mean cholesterol levels were significantly higher in group 1 compared with group 2. Cholesterol-lowering therapy in group 1 included general statins (77%) and high-intensity statins (27%). There was no evidence of differences in statin therapy use in patients with SH in primary care, endocrinology, or cardiology providers. Cardiologists initiated high-intensity statin therapy more frequently than primary care providers but not much more than endocrinologists. Both general statins and high-intensity statins were used less frequently in patients <40 years or >75 years.

No significant difference was found between groups for having established care with a primary care provider; however, a slightly larger proportion of group 1 patients were scheduled for future appointments with a primary care clinician. Incidence of endocrinology consultation did not differ significantly, but more participants in group 1 than group 2 were scheduled for cardiology visits.

“This study will serve as a startup project to optimize lipid treatment for high-risk individuals in primary care settings,” concluded the study authors.

Reference

Eid WE, Sapp EH, McCreless T, Nolan JR, Flerlage E. Prevalence and characteristics of patients with primary severe hypercholesterolemia in a multidisciplinary healthcare system. Am J Cardiol. Published online July 12, 2020. doi:10.1016/j.amjcard.2020.07.008

This article originally appeared on Clinical Advisor