Statin therapy discrepancy reported for some patients with severe hypercholesterolemia
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New data showed that 2% of patients receiving low- or moderate-intensity statin therapy had estimated severe hypercholesterolemia but received less aggressive therapy than those with maximum measured severe hypercholesterolemia.
Wael E. Eid, MD, endocrinologist and lipid specialist at St. Elizabeth Physicians Regional Diabetes Center in Covington, Kentucky, told Healio that his research team had previously conducted a study, published in the American Journal of Cardiology, that assessed the prevalence and treatment characteristics of patients with primary severe hypercholesterolemia.
“Clinical inertia was noted in that study, where only 27% of patients with severe hypercholesterolemia were treated with a high-intensity statin,” he said. “One potential reason for undertreatment in this high-risk group was a lack of identification of some of the patients with LDL cholesterol of 190 mg/dL and, as a result, a lack of proper treatment.”
For the present study, Eid and colleagues retrospectively determined prevalence, clinical presentation and treatment characteristics for patients treated with statin therapy who had an LDL value that was either an actual maximum electronic medical record-documented LDL of at least 190 mg/dL (group 1; n = 7,542) or an estimated pretreatment LDL of at least 190 mg/dL (group 2; n = 7,710). Researchers evaluated comorbidities and prescribed lipid-lowering therapies and performed statistical analyses to identify differences among individuals within and between groups.
Among 266,282 analyzed records, researchers determined that 7% met the definition for primary severe hypercholesterolemia.
Results indicated that the first group had more comorbidities than the second group. More patients with primary severe hypercholesterolemia were seen by primary care providers in both groups (group 1: 49.8% to 53%; group 2: 32.6-36.4) than by specialty providers (group 1: 4.1% to 5.5%; group 2: 2.1% to 3.3%).
As a result of this latter finding, Eid said, “More efforts led by cardiologists/lipidologists are needed to increase awareness of this high-risk group in the primary care sector, as are decision-makers to support the use of EMR data to estimate pretreatment LDL cholesterol for proper identification and, hopefully, proper care.”
In addition, researchers found that high-intensity lipid-lowering therapy was prescribed more frequently for the first group than the second group; however, moderate-intensity statins were prescribed more frequently for the second group (65% vs. 52%).
“Two percent of patients in our study population being treated with low- or moderate-intensity statins have an estimated LDL cholesterol 190 mg/dL, but receive less aggressive treatment than patients with a maximum measured LDL cholesterol 190 mg/dL,” the researchers wrote.
According to Eid, using estimated pretreatment LDL calculation “is an easily implementable tool that potentially can facilitate severe hypercholesterolemia diagnosis in primary care and specialty practice.”
Reference:
For more information:
Wael E. Eid, MD, can be reached at wael.eid@usd.edu.
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