Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014)

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Familial hypercholesterolemia (FH) or severe dyslipidemia (LDL-C >=190 mg/dL) (n=42471). Intervention: Definite/probable familial hypercholesterolemia (modified Dutch Lipid Clinic criteria) or severe dyslipidemia (LDL-C >=190 mg/dL) vs. General US adult population. Primary outcome: Current documented statin use.

Q: What does this research mean for the field?

Despite high rates of cholesterol screening and awareness exceeding 80%, documented statin use remains low among US adults with familial hypercholesterolemia (52.3%) and severe dyslipidemia (37.6%), with particularly low rates of high-intensity statin therapy. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Emily M. Bucholz; Angie Mae Rodday; Katherine Kolor; Muin J. Khoury; Sarah D. de Ferranti

doi:10.1161/circulationaha.117.032321

March 26, 2018Circulation

Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014)

View at Publisher

Ask AI

Bookmark

Share

Key result

Statin undertreatment remains widespread, with only ~52% of adults with familial hypercholesterolemia receiving therapy.

n=42,471

Why the study?

What are the national prevalence rates and sociodemographic predictors of cholesterol screening, awareness, and statin therapy among US adults with familial hypercholesterolemia or severe dyslipidemia?

Key Points

To determine national rates of cholesterol screening, awareness, and statin treatment, along with their predictors, among US adults with familial hypercholesterolemia or severe dyslipidemia.
Analyzed data from the 1999 to 2014 National Health and Nutrition Examination Survey encompassing 42 471 participants (weighted to represent 212 million US adults).
Identified familial hypercholesterolemia using Dutch Lipid Clinic criteria and severe dyslipidemia as low-density lipoprotein cholesterol levels ≥190 mg/dL.
Used multivariable logistic regression to evaluate sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy.
The estimated US prevalence of definite/probable familial hypercholesterolemia was 0.47% (standard error, 0.03%) and severe dyslipidemia was 6.6% (standard error, 0.2%).
Screening and awareness exceeded 80%, but documented statin use was 52.3% (standard error, 8.2%) in familial hypercholesterolemia and 37.6% (standard error, 1.2%) in severe dyslipidemia.
Only 30.3% of patients with definite/probable familial hypercholesterolemia taking statins received a high-intensity statin.

Study Design

Type

Cross-Sectional (n=42,471)

Multicenter

Yes

Structured PICO

What are the national prevalence rates and sociodemographic predictors of cholesterol screening, awareness, and statin therapy among US adults with familial hypercholesterolemia or severe dyslipidemia?

P

Population

42,471 nonpregnant US adults aged >=20 years (weighted to represent 212 million adults) from NHANES 1999-2014 evaluated for definite/probable familial hypercholesterolemia and severe dyslipidemia (LDL-C >=190 mg/dL).

E

Exposure

Presence of definite/probable familial hypercholesterolemia (modified Dutch Lipid Clinic criteria) or severe dyslipidemia (LDL-C ≥190 mg/dL after adjustment for lipid-lowering medication use).

C

Comparator

General US adult population and comparisons across sociodemographic and clinical subgroups (e.g., age, insurance status, usual source of care).

O

Outcome

Current documented statin use (assessed via medication containers brought to the mobile examination center).surrogate

Main Result

Absolute Event Rate: 52.3% vs 37.6%

Limitations

Definition of definite/probable FH was based on modified clinical Dutch Lipid Clinic criteria rather than genotyping.
Cholesterol screening, awareness, and self-reported treatment rates were estimated from questionnaires subject to recall or social desirability bias.
Statin use may be underestimated if participants neglected or refused to show medications, and lack of dosage data prevented exact differentiation of high- vs low-intensity statin doses.
Unable to differentiate between clinician failure to prescribe statins and participant nonadherence.
Over 50% of the population (58.5%) were missing data on LDL-C levels, requiring multiple imputation.
Definite/probable FH was defined using modified clinical Dutch Lipid Clinic criteria rather than genotyping, creating potential for misclassification.
Cholesterol screening, awareness, and self-reported treatment rates relied on self-reported questionnaires subject to recall or social desirability bias.
Lack of information on statin dosages prevented differentiation between high-dose and low-dose atorvastatin or rosuvastatin.
Inability to differentiate between failure to prescribe statins and patient nonadherence.
58.5% of the sample was missing LDL-C levels and 36.1% was missing family history of premature ASCVD, requiring multiple imputation.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In a nationally representative US sample, roughly half of adults with familial hypercholesterolemia and over 60% with severe dyslipidemia are not on statin therapy despite >80% screening and awareness rates, particularly among younger and uninsured individuals.

Abstract

BACKGROUND: Familial hypercholesterolemia (FH) and other extreme elevations in low-density lipoprotein cholesterol significantly increase the risk of atherosclerotic cardiovascular disease; however, recent data suggest that prescription rates for statins remain low in these patients. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. METHODS: Data from the 1999 to 2014 National Health and Nutrition Examination Survey were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among US adults (n=42 471 weighted to represent 212 million US adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol levels ≥190 mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. RESULTS: The estimated US prevalence of definite/probable FH was 0.47% (standard error, 0.03%) and of severe dyslipidemia was 6.6% (standard error, 0.2%). The frequency of cholesterol screening and awareness was high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% [standard error, 8.2%] of adults with definite/probable FH and 37.6% [standard error, 1.2%] of adults with severe dyslipidemia). Only 30.3% of patients with definite/probable FH on statins were taking a high-intensity statin. The prevalence of statin use in adults with severe dyslipidemia increased over time (from 29.4% to 47.7%) but not faster than trends in the general population (from 5.7% to 17.6%). Older age, health insurance status, having a usual source of care, diabetes mellitus, hypertension, and having a personal history of early atherosclerotic cardiovascular disease were associated with higher statin use. CONCLUSIONS: Despite the high prevalence of cholesterol screening and awareness, only ≈50% of adults with FH are on statin therapy, with even fewer prescribed a high-intensity statin; young and uninsured patients are at the highest risk for lack of screening and for undertreatment. This study highlights an imperative to improve the frequency of cholesterol screening and statin prescription rates to better identify and treat this high-risk population. Additional studies are needed to better understand how to close these gaps in screening and treatment.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Bucholz et al. (2018) conducted a cross-sectional in Familial hypercholesterolemia (FH) or severe dyslipidemia (LDL-C >=190 mg/dL) (n=42,471). Definite/probable familial hypercholesterolemia (modified Dutch Lipid Clinic criteria) or severe dyslipidemia (LDL-C >=190 mg/dL) vs. General US adult population was evaluated on Current documented statin use. Adults with definite/probable familial hypercholesterolemia or severe dyslipidemia had high screening and awareness (>80%), but documented statin use was low at 52.3% and 37.6%, respectively.

synapsesocial.com/papers/6a5c422df18ae74a40a674cb https://doi.org/10.1161/circulationaha.117.032321

View at Publisher

Ask AI

Bookmark

Share

Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading