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A Familial Hypercholesterolemia Human Liver Chimeric Mouse Model Using Induced Pluripotent Stem Cell-derived Hepatocytes
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[Cholesterol is still high. So what do we do now? Treatment of uncontrolled hypercholesterolaemia over a year]
J Tobias Ferrer1, R Sanjuán Cortés, M Fàbrega Camprubí
1Centro de Atención Primaria PlaCa Catalunya. ABS Manresa-2. Manresa, Barcelona, Spain. jtobias@medynet.com
Insights
Lipid-lowering drug use increased in primary care, improving lipid control for hypercholesterolaemia patients. However, over half still had suboptimal cholesterol levels after treatment.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypercholesterolaemia (HC) management in primary care is crucial for cardiovascular risk reduction.
- Current lipid-lowering treatment effectiveness in routine clinical practice requires evaluation.
Purpose of the Study:
- To assess the effectiveness of lipid-lowering treatments in primary care settings for patients with hypercholesterolaemia.
- To evaluate lipid control outcomes based on normal clinical practice.
Main Methods:
- A before-and-after semi-experimental study was conducted in nine urban primary care clinics.
- 187 patients with hypercholesterolaemia (LDL-c > 190 mg/dl) were followed for 12 months under normal clinical practice.
- Lipid profiles and treatments were recorded, with lipid control assessed against cardiovascular risk criteria.
Main Results:
- Prescription of lipid-lowering drugs increased significantly (27% to 52%, p < 0.005), primarily statins.
- Low-density lipoprotein cholesterol (LDL-c) decreased by 12% (95% CI, 9-15%).
- Deficient lipid control reduced from 91% to 61% (p < 0.005), with only 16% achieving optimal control.
Conclusions:
- Routine primary care lipid-lowering treatment led to increased drug use and improved lipid control over 12 months.
- Despite improvements, a significant proportion (61%) of hypercholesterolaemia patients did not achieve optimal lipid levels.
- Further optimization of lipid management in primary care is warranted.
Objective:
To find the effectiveness of lipid-lowering treatment, based on normal clinical practice in primary care, on lipid control of patients with clear hypercholesterolaemia (HC). Design. Semi-experimental before-and-after intervention study.
Setting:
Urban health centre.
Participants:
187 patients known to have lipaemia, with total or LDL cCholesterol (cLDL) above 270 and 190 mg/dl, respectively.Intervention. Normal clinical practice for twelve months in nine primary care clinics.
Main Measurements:
The lipid profile and lipid-lowering treatment were recorded at the start of the study and after twelve months. Lipid control (as a function of cLDL) was evaluated as optimal, acceptable or deficient, as a function of the cardiovascular risk, following the criteria of the Spanish Arteriosclerosis Society (1994).
Results:
In 27% of cases, no visit relating to HC was recorded by the patient s doctor. The number of patients treated with lipid-lowering drugs grew from 50 to 98 (27 vs 52%, p < 0,005), fundamentally at the expense of statin treatment. After twelve months, there were significant drops in the plasma concentration of cLDL (12%, 95%CI, 9 to 15%) and in the percentage of patients with deficient control, which fell from the initial 91% to 61% (p < 0.005), although only 16% reached optimal control.
Conclusions:
After a year, under conditions of normal clinical practice, there was an increase in the use of lipid-lowering drugs and improvement in lipid control, though a bit over half the patients (61%) with clear hypercholesterolaemia maintained concentrations requiring treatment.
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