Clinical determinants and treatment gaps in familial hypercholesterolemia: Data from a multi-ethnic regional health service
| Autor: | Chen Shapira, Moshe Y. Flugelman, Gil Lavie, Ayman Jubran, David A. Halon, Barak Zafrir |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors Databases Factual Epidemiology Ethnic group Familial hypercholesterolemia 030204 cardiovascular system & hematology Health services 0302 clinical medicine Risk Factors Electronic Health Records Medicine 030212 general & internal medicine Age of Onset Israel Practice Patterns Physicians' Child Lipoprotein cholesterol Atherosclerotic cardiovascular disease Anticholesteremic Agents Process Assessment Health Care Middle Aged Treatment Outcome Child Preschool Practice Guidelines as Topic Female lipids (amino acids peptides and proteins) Guideline Adherence Cardiology and Cardiovascular Medicine medicine.drug Adult Healthcare database medicine.medical_specialty Adolescent Risk Assessment Hyperlipoproteinemia Type II Young Adult 03 medical and health sciences Ezetimibe Diabetes mellitus Internal medicine Humans Aged business.industry Infant Newborn Infant Cholesterol LDL Atherosclerosis medicine.disease Professional Practice Gaps Physical therapy business Biomarkers |
| Zdroj: | European Journal of Preventive Cardiology. 24:867-875 |
| ISSN: | 2047-4881 2047-4873 |
| Popis: | Background Familial hypercholesterolemia is characterized by markedly increased low-density lipoprotein cholesterol and risk for premature atherosclerotic cardiovascular disease. Models of care vary and reflect differing health policies and resources. The availability of electronic databases may enable better identification and assessment of familial hypercholesterolemia in the community. Methods A regional healthcare database was utilized to identify patients with a high probability of familial hypercholesterolemia, clinically defined by age-dependent-peak low-density lipoprotein cholesterol cutoffs and exclusion of secondary causes of severe hypercholesterolemia. Clinical characteristics, low-density lipoprotein cholesterol goal attainment, and treatment gaps were investigated. Results Probable familial hypercholesterolemia was diagnosed in 1932 of 685,314 individuals (1:355; median age 47 years). Atherosclerotic cardiovascular disease was present in 16.3% of adults (38% in males aged 50-74 years). Median peak low-density lipoprotein cholesterol was 264 mg/dl (interquartile range 252-288). Statins and/or ezetimibe were prescribed to 83% of patients and high-intensity statins to 53%, whereas prescriptions were filled in 57% and 40% cases respectively over the last six months, p 0.001. Treatment gaps were wider among ethnic minorities, younger individuals, and those without atherosclerotic cardiovascular disease. Low-density lipoprotein cholesterol 100 mg/dl was attained in 10.1% overall and 28.7% of those with atherosclerotic cardiovascular disease. Predictors of low-density lipoprotein cholesterol goal attainment included recent issue of high-intensity statins, presence of atherosclerotic cardiovascular disease, diabetes, older age and lack of smoking. Conclusions The population with high probability for familial hypercholesterolemia was characterized by low attainment of low-density lipoprotein cholesterol treatment goals despite high prescription rates of lipid-lowering medications. Low utilization of intensified therapies, non-adherence, and ethnic disparities were contributing factors. These findings emphasize the need to improve awareness and quality of care of familial hypercholesterolemia in the community. |
| Databáze: | OpenAIRE |
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