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Familial hypercholesterolemia care by Dutch pediatricians-mind the gaps
Sibbeliene E van den Bosch1,2, Barbara A Hutten3,4, Shirin Ibrahim5
1Department of Pediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.e.vandenbosch@amsterdamumc.nl.
Insights
Dutch pediatricians show gaps in recognizing familial hypercholesterolemia (FH) and its risks in children. Improved education is crucial for early detection and lifelong atherosclerotic cardiovascular disease (ASCVD) prevention.
Area of Science:
- Pediatric Cardiology
- Genetics
- Public Health
Background:
- Familial hypercholesterolemia (FH) causes high LDL-cholesterol, increasing premature atherosclerotic cardiovascular disease (ASCVD) risk.
- Atherosclerosis begins in childhood, necessitating early intervention.
- Pediatricians are key in identifying and managing FH in children.
Purpose of the Study:
- To identify knowledge and awareness gaps in FH care among Dutch pediatricians.
- To enhance pediatricians' ability to detect and treat children with FH.
- To improve early management of FH and reduce long-term ASCVD risk.
Main Methods:
- An anonymous online survey was distributed to Dutch pediatricians via the Dutch Association of Pediatrics newsletter and hospital departments.
- The survey comprised 26 questions on FH care in children, completed without external resources.
- Data was collected from 158 pediatricians between September and November 2023.
Main Results:
- Most pediatricians (76.6%) identified a typical FH lipid profile, but 43.0% underestimated FH prevalence.
- Significant percentages underestimated ASCVD risk (37.3%) and were unaware of it (25.9%).
- While 70.9% defined FH correctly, only 42.4% selected appropriate treatments like statins and ezetimibe.
Conclusions:
- Substantial gaps exist in Dutch pediatricians' knowledge and awareness regarding FH in children.
- Educational and training initiatives are needed to improve FH detection and management.
- Early, effective FH care is essential to mitigate lifelong ASCVD risk starting in childhood.
Purpose:
Familial hypercholesterolemia (FH) leads to elevated low-density lipoprotein cholesterol levels, which increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). Since the first functional and morphologic changes of the arterial wall occur in childhood, treatment should start early in childhood to mitigate the elevated risk of ASCVD. Pediatricians play an important role in the detection and care of children with FH. In this study, we aim to explore potential gaps in FH care amongst Dutch pediatricians, in order to enhance their knowledge and awareness of detecting and treating children with FH.
Methods:
An anonymous online survey, deployed using Google Forms, including 26 closed and semi-closed questions on FH care in children was distributed by the Dutch Association of Pediatrics via a newsletter to which the majority of the practicing Dutch pediatricians subscribe. In addition, we requested that the pediatric departments of all Dutch hospitals in the Netherlands distribute this survey personally among their employed pediatricians. Respondents were instructed to answer the questions without any help or use of online resources.
Results:
Between September 1st, 2023 and November 1st, 2023, 158 (an estimated 11% response rate) Dutch pediatricians completed the survey. They reported a median (IQR) of 15.0 (6.0-22.0) years of experience as a pediatrician, and 34 (21.5%) were working in academic hospitals. The majority (76.6%) of pediatricians correctly identified a typical FH lipid profile but 68 (43.0%) underestimated the true prevalence of FH (1:300). Underestimation and unawareness of the increased risk of FH patients for ASCVD were reported by 37.3% and 25.9% of pediatricians, respectively. Although 70.9% of the pediatricians correctly defined FH, only 67 (42.4%) selected statins and ezetimibe to treat severe hypercholesterolemia.
Conclusions:
The results of this study suggest significant gaps in knowledge and awareness of FH in children among Dutch pediatricians. FH care in children needs improvement through educational and training initiatives to mitigate the life-long risk of ASCVD from early life.
What Is Known:
• Familial hypercholesterolemia (FH) leads to elevated LDL-cholesterol levels, which increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). • The process of atherosclerosis starts in childhood • Pediatricians play an important role in the detection and treatment of children with FH.
What Is New:
• Our results highlight significant gaps in care for children with FH amongst pediatricians and this may lead to suboptimal detection and treatment. • FH care in children needs improvement by educational initiatives to ultimately prevent ASCVD in adulthood.
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