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Published on: September 15, 2018
Treatment Inertia in Patients With Familial Hypercholesterolemia
Anatoly Langer1, G B John Mancini2, Mary Tan1
1Canadian Heart Research Centre Toronto ON Canada.
Insights
Familial hypercholesterolemia (FH) patients show significant treatment inertia, often not reaching lipid-lowering goals. Targeted education is crucial for improving care gaps in FH management.
Area of Science:
- Cardiology
- Genetics
- Pharmacology
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high low-density lipoprotein cholesterol (LDL-C).
- Patients with FH, especially those with existing cardiovascular disease (CVD), require effective lipid-lowering therapy.
- A care gap exists in achieving therapeutic lipid targets in FH patients.
Purpose of the Study:
- To investigate the care gap in lipid-lowering therapy for patients with familial hypercholesterolemia (FH).
- To assess treatment inertia in FH patients, including those with co-existing cardiovascular disease (CVD).
- To evaluate the effectiveness of online reminders in improving treatment adherence and achieving LDL-C targets.
Main Methods:
- Enrolled 2009 patients with cardiovascular disease (CVD) or FH and elevated LDL-C (>2.0 mmol/L) despite maximally tolerated statin therapy.
- Physicians received online reminders of treatment recommendations during follow-up.
- Compared baseline characteristics and treatment outcomes between FH and CVD patient groups.
Main Results:
- Patients with FH were younger, more likely female, non-White, and had higher baseline LDL-C compared to CVD-only patients.
- FH patients received less statin therapy at baseline (70.6% vs. 79.2%).
- Achieving LDL-C targets (≥50% reduction or <2.5 mmol/L for FH; ≤2.0 mmol/L for CVD) was suboptimal, with only 22.0% of FH-only patients reaching the primary endpoint compared to 45.8% of CVD-only patients.
Conclusions:
- Significant treatment inertia persists in patients with FH, even those with established CVD.
- Current lipid-lowering strategies are insufficient for a substantial proportion of FH patients.
- Continued education and interventions focused on FH patients are necessary to bridge the care gap and improve outcomes.
Abstract:
Background We studied care gap in patients with familial hypercholesterolemia (FH) with respect to lipid-lowering therapy. Methods and Results We enrolled patients with cardiovascular disease (CVD) or FH and low-density lipoprotein-cholesterol >2.0 mmol/L despite maximally tolerated statin therapy. During follow-up physicians received online reminders of treatment recommendations of 2009 patients (median age, 63 years, 42% women), 52.4% had CVD only, 31.7% FH only, and 15.9% both CVD and FH. Patients with FH were younger and more likely to be women and non-White with significantly higher baseline low-density lipoprotein-cholesterol level (mmol/L) as compared with patients with CVD (FH 3.92±1.48 versus CVD 2.96±0.94, P<0.0001). Patients with FH received less statin (70.6% versus 79.2%, P=0.0001) at baseline but not ezetimibe (28.1% versus 20.4%, P=0.0003). Among patients with FH only, 45.3% were at low-density lipoprotein target (≥ 50% reduction from pre-treatment level or low-density lipoprotein <2.5 mmol/L) at baseline and increasing to 65.8% and 73.6% by visit 2 and 3, respectively. Among patients with CVD only, none were at recommended level (≤2.0 mmol/L) at baseline and 44.3% and 53.3% were at recommended level on second and third visit, respectively. When primary end point was analyzed as a difference between baseline and last available follow-up observation, only 22.0% of patients with FH only achieved it as compared with 45.8% with CVD only (P<0.0001) and 55.2% with both FH+CVD (P<0.0001). Conclusions There is significant treatment inertia in patients with FH including those with CVD. Education focused on patients with FH should continue to be undertaken.
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