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Disparities of care in patients with FH pose ‘great opportunity’ for awareness
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ATLANTA — Similar disparities with regards to CVD are also seen in patients with familial hypercholesterolemia, and more work needs to be done to bring awareness and more research into this area, according to a presentation at the FH Foundation’s FH Global Summit.
“There’s little written or published about disparities of care in FH,” Laurence Sperling, MD, FACC, FAHA, FACP, founder and director of preventive cardiology at the Emory Clinic, co-director of the cardiovascular disease fellowship program at Emory University and past president of the American Society for Preventive Cardiology, said during the presentation. “This is a great opportunity that we all have to both learn and to try to focus on populations that may be at the highest risk living with FH.”
It is important to focus on trying to diagnose conditions like FH in a pre-disease state, which can potentially negate risk factors, and to keep in mind all patients with CV risk, not just patients with FH, to improve health promotion and disease prevention, according to the presentation.
Approximately 3% of people in the U.S. have ideal CV health and an estimated 10% or more of Americans have poor CV health.
“There are great inequities among this population, with disparities in age, gender, education, ethnicity and geography,” Sperling said during the presentation.
Although health care professionals should focus on the prevention and treatment of traditional CV risk factors such as hypercholesterolemia, other factors should be considered such as social determinants of health.
“For many in our population, [these] are greater determinants of the risk for diseases than traditional risk factors,” Sperling said during the presentation. “The way we approach these social determinants of health have to be very different from the way we think about addressing traditional cardiovascular risk factors.”
Where a patient lives can be a stronger determinant of health and disease compared with their genetics. Location as a determinant of health and disease can differ between two towns that are as little as a 15-minute drive apart, according to the presentation.
Disparities also exist in the implementation and utilization of evidence-based guidelines and treatments, along with barriers on poor awareness, knowledge, stigma, costs and concerns, according to the presentation. This can lead to medical mistrust and limited access within general care systems.
“We definitely need a multi-stakeholder approach to address the challenges we have with disparities,” Sperling said during the presentation.
FH remains a condition that is “hidden in plain sight” despite the progress made, particularly by the FH Foundation, Sperling added. The highest risk in patients with FH is seen in those who live in areas with significant disparities and challenges associated with health and disease.
Women are often diagnosed with FH later in life, have a higher rate of premature CVD and are less likely to be on a statin compared with men. Similar patterns are also seen in black patients compared with white patients, Sperling said.
Black patients are the most understudied group with FH both nationally and internationally, according to the presentation.
“We have a great opportunity with the datasets [we have] to learn more about this population,” Sperling said. “I’m going to challenge this community to learn more, become more aware, focus on this population who may be at the highest risk.” – by Darlene Dobkowski
Reference:
Sperling L. Disparities in Care. Presented at: The FH Foundation’s FH Global Summit; Oct. 20-21, 2019; Atlanta.
Disclosure: Sperling reports no relevant financial disclosures.