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Changing FH care requires effort from clinicians, researchers, patients
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ATLANTA — Information from research, advocacy and education is needed to potentially change the care of patients with familial hypercholesterolemia, according to a presentation at the FH Foundation’s FH Global Summit.
Patients with FH have the same risk as those with atherosclerotic CVD, and when patients have both conditions, their risk increases by five times, Nanette K. Wenger, MD, MACC, MACP, FAHA, professor of medicine (cardiology) at Emory University School of Medicine, consultant at Emory Heart and Vascular Center and Cardiology Today Editorial Board Member, said during the presentation.
Despite what has been learned from the CASCADE FH registry, significant disparities in the care of FH remain, particularly in women and black and Asian patients. These groups are not prescribed statins as often as white men. In addition, black and Asian patients do not achieve the same LDL goals as white men.
“We have to recognize these disparities in our clinical practice,” Wenger said during the presentation.
Pregnancy in women with FH is another issue, as most health care professionals are uninformed about this, according to the presentation. Prepregnancy counseling and contraception advice become very important for these women, with the emphasis that proper planning can increase the likelihood of a healthy pregnancy and healthy children. Healthy lifestyles and the discontinuation of statins and other lipid-lowering therapies should also be stressed. Although it is not well known when women can resume statins after pregnancy, it has been established that these children should be screened for FH.
Shared decision-making becomes important in patients with FH.
“I’m not sure all of us do that as well as we should,” Wenger said during the presentation.
Health care providers should empower patients through awareness and education. In addition, clinicians should match the intensity of the intervention to the patient’s risk and emphasize how behavioral changes can dramatically decrease the number of patients affected by CHD annually.
“This is a partnership between individuals and their health care providers,” Wenger said during the presentation.
Some lifestyle interventions that should be used in patients with FH include tactics such as smoking cessation and walking, especially for women. Wenger also described a 250:250 rule for weight control, in which exercising an extra 250 calories per day and eating 250 fewer calories per day can potentially contribute to a pound of weight loss per week.
Advocacy is a key driver of an increased awareness that FH is a global public health priority, Wenger said. It is important to make patients aware that there are safe and effective medications such as generic statins and ezetimibe.
Despite the knowledge of what must be done to increase awareness, there are several challenges that remain, including care disparities, available and affordable access to more potent lipid-lowering drugs and limited government programs and other research possibilities.
“Each feeds the other: the information from research, the education, the advocacy. That is what we’re all about,” Wenger said during the presentation. – by Darlene Dobkowski
Reference:
Wenger NK. Science, policy and behavior: Necessary ingredients for changing care. Presented at: The FH Foundation’s FH Global Summit; Oct. 20-21, 2019; Atlanta.
Disclosure: Wenger reports she consults for Amarin, AstraZeneca and Janssen and has other financial relationships with AstraZeneca, Boehringer Ingelheim, the Department of Defense and the NHLBI.