Study finds gap in care of patients with familial hypercholesterolaemia

Treatment inertia appears to be common among patients with familial hypercholesterolaemia (FH) including those with cardiovascular disease (CVD), with most of the patients not achieving the recommended low-density lipoprotein cholesterol (LDL-C) level, a study has found.

Researchers looked at 2,009 patients (median age 63 years, 42 percent female) with CVD and/or FH and LDL-C level >2.0 mmol/L despite maximally tolerated statin therapy. These patients were attended to by 177 physicians (58 percent primary care and 42 percent specialists).

Of the patients, 1,054 (52.4 percent) had CVD only, 636 (31.7 percent) had FH only, and 319 (15.9 percent) had both CVD and FH. Patients with FH only vs CVD only tended to be younger, female, and non‐White, as well as have slightly lower systolic and slightly higher diastolic blood pressure and heart rate.

Baseline LDL-C levels were significantly higher in the FH vs CVD group (mean, 3.92 vs 2.96 mmol/L; p<0.0001). Patients with FH received statin less frequently (70.6 percent vs 79.2 percent; p=0.0001) but more commonly used ezetimibe (28.1 percent vs 20.4 percent; p=0.0003) relative to patients with CVD.

Among patients with FH only, 45.3 percent had their LDL-C at target levels (≥50-percent reduction from pretreatment level or LDL-C <2.5 mmol/L) at baseline. This proportion increased to 65.8 percent by visit 2 and 73.6 percent by visit 3, with each visit about 4–6 months apart.

None of the patients with CVD had LDL-C at recommended levels (≤2.0 mmol/L) at baseline, but 44.3 percent achieved the target by visit 2 and 53.3 percent by visit 3.

Between baseline and last available follow‐up visit, only 22.0 percent of patients with FH only achieved the target LDL-C level as compared with 45.8 percent of patients with CVD only (p<0.0001) and 55.2 percent of those with both FH and CVD (p<0.0001).

The present data underscore a need for greater physician education and support for implementation of therapeutic recommendations focused on patients with FH.