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Statin therapy prescribed less often in adult congenital heart disease
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Adults with congenital heart disease were less likely to be prescribed statin therapy for primary prevention compared with those without the condition regardless of 10-year atherosclerotic CVD risk scores, according to a study published in The American Journal of Cardiology.
“This creates clear directive for targeted efforts to optimize preventative ASCVD management,” Laura D. Flannery, MD, cardiology fellow at Massachusetts General Hospital, and colleagues wrote. “As the [adults with congenital heart disease] population is living longer, ASCVD has increasing implications on their overall health. Primary care physicians, primary cardiologists and ASCVD cardiologists alike must engage in active surveillance of ASCVD risk factors and prioritize guideline-based primary prevention in this population to further mitigate ASCVD risk.”
Researchers analyzed data from 248 patients with congenital heart disease of moderate or great complexity (mean age, 51 years; 48% women). Those with a history of atherosclerotic disease including stroke or MI were excluded.
An age- and sex-matched control group of 744 patients without adult congenital heart disease or CAD was included in the analysis (mean age, 51 years; 48% women).
Information from lipid panels and electronic health records were used to calculate 10-year atherosclerotic CVD risk with the 2013 American College of Cardiology/American Heart Association risk calculator. The 2013 ACC/AHA cholesterol guidelines were used to determine indications for statin treatment.
Adults with congenital heart disease had a similar predicted 10-year atherosclerotic CVD risk as the control group (4.6% vs. 5.1%, respectively; P = .32).
Compared with the control group, patients with congenital heart disease were less likely to smoke (8.1% vs. 14.6%; P = .008) and had lower total cholesterol (183 mg/dL vs. 192.6 mg/dL; P < .001). They also had higher hypertension rates (38.7% vs. 28.5%; P = .003) and lower HDL (52.6 mg/dL vs. 55.3 mg/dL; P = .03).
Statin therapy was appropriately prescribed to 42.3% of patients with congenital heart disease compared with 59% in the control group (P = .04).
“There are several possible explanations for this disparity,” Flannery and colleagues wrote. “It is possible that shorter life expectancy of patients with [adult congenital heart disease] makes primary prevention of ASCVD seem less important. Additionally, the better control of risk factors such as LDL, obesity and smoking in patients with [adult congenital heart disease] as compared with their peers may influence the perception of risk and decision, consciously or subconsciously, to not initiate statin or aspirin therapy. Finally, patients with [adult congenital heart disease] may have more frequent true or perceived contraindications to statin therapy.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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