Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Introduction: Appropriate lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice in an underserved population, with a focus on statin treatment. Methods: We reviewed the records of 1,042 consecutive patients seen between August 2018 and August 2019 in an outpatient academic primary care clinic. Eligibility for statin and other lipid-lowering therapies was determined based on the 2018 American Heart Association and American College of Cardiology (AHA/ACC) guideline on the management of blood cholesterol. Results: Among 464 statin-eligible patients, age was 61.1 +/- 10.4 years and 53.9% were female. Most patients were Black (47.2%), followed by Hispanic (45.7%), and White (5.0%). Overall, 82.1% of patients were prescribed a statin. Statin-eligible patients who qualified based only on a 10-year ASCVD risk > 7.5% were less likely to be prescribed a statin (32.8%, p<0.001). After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age > 55 years (OR = 4.59 [95% CI 1.09 - 16.66], p = 0.026), hypertension (OR = 2.38 [95% CI 1.29 - 4.38], p = 0.005) and chronic kidney disease (OR = 3.95 [95% CI 1.42 - 14.30], p = 0.017). Factors independently associated with statin undertreatment were Black race (OR = 0.42 [95% CI 0.23 - 0.77], p = 0.005), and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 [95% CI 0.07 - 0.25], p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to Black patients (86.8% vs 77.2%). Conclusion: Statin underprescription is seen in approximately one out of five eligible patients, and is independently associated with Black race, younger age, fewer comorbidities, and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to Black patients.

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Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Healthcare ◽

10.3390/healthcare8040361 ◽

2020 ◽

Vol 8 (4) ◽

pp. 361

Author(s):

Giselle Alexandra Suero-Abreu ◽

Aris Karatasakis ◽

Sana Rashid ◽

Maciej Tysarowski ◽

Analise Douglas ◽

...

Keyword(s):

Statin Therapy ◽

Medical Center ◽

Statin Treatment ◽

Population Based ◽

Lipid Lowering ◽

Atherosclerotic Cardiovascular Disease ◽

Black Race ◽

Black Patients ◽

Hispanic Patients ◽

Ascvd Risk

Lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09–16.66), p = 0.026), hypertension (OR = 2.38 (95% CI 1.29–4.38), p = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42–14.30), p = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23–0.77), p = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07–0.25), p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). Statin underprescription is seen in approximately one out of five eligible patients and is independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to black patients.

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Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction

Journal of Pharmacy Practice ◽

10.1177/0897190021999790 ◽

2021 ◽

pp. 089719002199979

Author(s):

Roshni P. Emmons ◽

Nicholas V. Hastain ◽

Todd A. Miano ◽

Jason J. Schafer

Keyword(s):

Cardiovascular Disease ◽

Logistic Regression ◽

Statin Therapy ◽

Risk Reduction ◽

Blood Cholesterol ◽

Control Group ◽

Atherosclerotic Cardiovascular Disease ◽

Ascvd Risk ◽

Living With Hiv ◽

To Receive

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

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338. Patients Living with HIV Infection Are Less Likely to Receive the Correct Intensity of Statin Therapy for Cardiovascular Disease Risk Reduction

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.411 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S179-S180

Author(s):

Jason J Schafer ◽

Roshni Patel ◽

Nicholas V Hastain ◽

Todd Miano

Keyword(s):

Cardiovascular Disease ◽

Statin Therapy ◽

Risk Reduction ◽

Univariate Analysis ◽

Blood Cholesterol ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Panel ◽

Ascvd Risk ◽

Living With Hiv ◽

To Receive

Abstract Background Patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD) should receive risk reduction interventions recommended in current guidelines. This includes routine ASCVD risk assessments and when eligible, statins selected and dosed to achieve appropriate low-density lipoprotein cholesterol (LDL-C) reduction. Recent studies suggest that statins are underprescribed in PLWH, but none have assessed if eligible patients receive the correct statin intensity compared with uninfected controls. Methods This retrospective study evaluated statin eligibility and prescribing among consecutive patients in an HIV clinic and an internal medicine clinic at an urban, academic medical center from June-September 2018. To determine statin eligibility, the 2013 American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk was used. Patients aged 40–75 that had a lipid panel obtained within the last year were included. All patients were assessed to determine eligibility for and actual treatment with appropriate statin therapy. Characteristics of patients correctly and incorrectly treated with statins were compared with chi-square testing and predictors for receiving correct statin therapy were determined with logistic multivariable regression. Results A total of 221/300 study subjects were statin eligible (Table 1). While many eligible PLWH were receiving a statin (54/106), considerably fewer were on the correct statin intensity for their benefit group (33/106). In the univariate analysis (Table 2), correctly treated patients were less likely to be PLWH or female, and were more likely to have polypharmacy and hypertension. In the multivariable logistic regression analysis (Table 3), PLWH (OR 0.26, CI95 0.12–0.57)) were significantly less likely to receive correct statin therapy, while those with concomitant polypharmacy were significantly more likely to receive correct statin therapy (OR 5.52, CI95 1.94, 15.69). Conclusion This study reveals that PLWH may be at a substantial disadvantage in terms of receiving correct statin therapy for ASCVD risk reduction. This finding may be particularly important given the heightened risk for ASCVD in this patient population. Disclosures All authors: No reported disclosures.

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Abstract 16936: Implications of the 2013 ACC/AHA Cholesterol Guidelines for Adults in Contemporary Cardiovascular Practice: Insights from the NCDR® PINNACLE Registry®

Circulation ◽

10.1161/circ.130.suppl_2.16936 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Thomas Maddox ◽

William Borden ◽

Fengming Tang ◽

Salim Virani ◽

William Oetgen ◽

...

Keyword(s):

Statin Therapy ◽

Current Practice ◽

Risk Group ◽

National Registry ◽

Lipid Lowering ◽

Fixed Dose ◽

Atherosclerotic Cardiovascular Disease ◽

Ascvd Risk ◽

Cholesterol Guidelines ◽

Testing Patterns

Background: In a significant update, the 2013 ACC/AHA cholesterol guidelines recommend fixed-dose statin therapy for those at risk and do not recommend non-statin therapies or treatment to target LDL-C levels, limiting the need for repeated LDL-C testing. We examined the implications of these updated guidelines on current lipid treatment and testing patterns in a national registry of cardiology practices. Methods: Using NCDR® PINNACLE Registry® data from 2008 to 2012, we assessed current practice patterns as a function of the 2013 cholesterol guidelines. Lipid-lowering therapies and LDL-C testing patterns by patient risk group (atherosclerotic cardiovascular disease (ASCVD), diabetes, off-treatment LDL-C ≥190mg/dL, or an estimated 10-year ASCVD risk ≥7.5%) were described. Results: Among a cohort of 1,174,545 patients, 1,129,205 (96.1%) were statin-eligible (91.2% ASCVD, 6.6% diabetes, 0.3% off-treatment LDL-C ≥190mg/dL, 1.9% estimated 10-year ASCVD risk ≥7.5%). 377,311 (32.4%) patients were not receiving statin therapy and 259,143 (22.6%) were receiving non-statin therapies. 20.8% patients had 2 or more LDL-C assessments during the study period, and 7.0% had more than 4 assessments. Conclusions: In U.S. cardiovascular practices, 32.4% of statin-eligible patients, as defined by the 2013 ACC/AHA cholesterol guidelines, were not currently receiving them. In addition, 22.6% were receiving non-statin lipid-lowering therapies and 20.8% had repeated LDL-C testing. Achieving concordance with the new cholesterol guidelines would result in significant increases in statin use, as well as significant reductions in non-statin therapies and laboratory testing.

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Abstract 10426: One Year Impact of the 2013 Cholesterol Guidelines on Patterns of Lipid Lowering Treatment

Circulation ◽

10.1161/circ.132.suppl_3.10426 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Josephine N Tran ◽

Tzu Chun Kao ◽

Toros Caglar ◽

Karen M Stockl ◽

Heidi C Lew ◽

...

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Arterial Disease ◽

Statin Treatment ◽

Lipid Lowering ◽

High Dose ◽

Atherosclerotic Cardiovascular Disease ◽

Patients With Diabetes ◽

Cholesterol Guidelines ◽

One Year

Background: In 2013, national organizations issued new cholesterol guidelines to emphasize evidence-based treatment with moderate- to high-dose statins for patients at high risk for atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease, stroke, and peripheral arterial disease. Whether these new guidelines have influenced patterns of treatment one year after their dissemination is unknown. Methods: Using pharmacy and medical claims from a large U.S. health insurance organization, we identified 610,535 adult patients with ASCVD (n=301,440) or diabetes mellitus (n=309,095) and examined statin treatment rates before and one year after the new cholesterol guidelines. Among patients receiving statins post-guidelines, we also evaluated whether patients were treated with guideline-recommended intensity of statin therapy. A standardized difference (SD) of at least 10% was required to declare the effect size meaningful. Results: Overall, there was no change in statin treatment rates for patients with ASCVD (48.0% before guidelines vs. 47.3% after, SD [1.4]) or diabetes (50% vs. 51.5% after, SD [2.4]). Statin initiation rates among patients not on statins pre-guidelines were 10.1% in patients with ASCVD and 14.3% in patients with diabetes, and these gains were offset by 13.0% and 12.2% statin discontinuation rates among ASCVD and diabetes patients, respectively. Among patients taking statins one year post-guidelines, 80% of patients with ASCVD and < 75 years of age were not on guideline-recommended high-intensity statin therapy, whereas >75% of patients with ASCVD and >75 years of age or patients with diabetes were on moderate- or high-intensity statin treatment. Conclusion: One year after dissemination of the new 2013 cholesterol guidelines, overall treatment rates with statins among patients with ASCVD and diabetes have not changed appreciably, and many patients remain either untreated or under-treated. Character Count: 1683

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941. Incarcerated patients living with HIV: Atherosclerotic cardiovascular disease risk and management

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1127 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S503-S504

Author(s):

Sarah M Michienzi ◽

Thomas D Chiampas ◽

Amy Valkovec ◽

Siria Arzuaga ◽

Mahesh C Patel ◽

...

Keyword(s):

Cardiovascular Disease ◽

Statin Therapy ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Heart Association ◽

Blood Cholesterol ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Panel ◽

Ascvd Risk ◽

Living With Hiv

Abstract Background The 2018 American Heart Association and American College of Cardiology (AHA/ACC) 2018 Guideline on the Management of Blood Cholesterol included human immunodeficiency virus (HIV) as an atherosclerotic cardiovascular disease (ASCVD) risk enhancer for the first time. Our study investigates if patients living with HIV in the Illinois Department of Corrections (IDOC) were prescribed appropriate HMG-CoA reductase inhibitor (statin) therapy following release of these guidelines based on risk. Methods This was a retrospective study of patients with > 1 visit in our multidisciplinary HIV IDOC Telemedicine Clinic from 1/1/19-6/1/19. Our prescriptive authority is limited to HIV and directly related conditions, and we provide recommendations to on-site providers for other comorbidities. Included patients were > 18 years of age, HIV positive, and incarcerated within IDOC. Excluded patients had existing ASCVD. Data from the first visit in the study period were extracted from the electronic medical record and analyzed utilizing descriptive statistics. Primary objectives were to quantify ASCVD risk and appropriate statin use in our population. Results Of the 158 patients included, average age was 42 years. The majority were male (89%), Black (73%), overweight/obese (117/148, 79%), on an integrase single-tablet regimen (78%), with CD4 >200 cells/µL (97%), and HIV RNA < 20 copies/mL (85%). Of the 18 females, 8 were transgender. Within the prior year, 65% had a lipid panel. For the 50 patients meeting criteria for 10-year ASCVD estimation, median (range) risk was 6.6% (0.8% - 31.9%). Only 12 patients were on statins. Of these, all were indicated per AHA/ACC guidelines with 10 prescribed appropriate intensity. An additional 45 patients had indications for statins but were untreated. In total, 47 patients (30%) were not receiving appropriate statin therapy. Conclusion Results of our study suggest ASCVD risk management is an area of improvement for inmates living with HIV, especially as we look towards caring for an aging HIV population. Future directions include comparing these data to data from a later time point to evaluate time for guideline uptake. Disclosures Thomas D. Chiampas, PharmD, BCPS, AAHIVP, Gilead (Employee)

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Abstract 14646: Internal Medicine Housestaff Perceptions of Statins and ACC/AHA Blood Cholesterol Guidelines

Circulation ◽

10.1161/circ.130.suppl_2.14646 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Peter Flueckiger ◽

Stephen Juraschek ◽

Micah Eades ◽

Amit Khera ◽

Michael Blaha ◽

...

Keyword(s):

Internal Medicine ◽

Side Effects ◽

Statin Therapy ◽

Perceived Risk ◽

Gastrointestinal Symptoms ◽

Blood Cholesterol ◽

Atherosclerotic Cardiovascular Disease ◽

Prescribing Practices ◽

Ascvd Risk ◽

Cholesterol Guidelines

Background: Statins are integral in the prevention of atherosclerotic cardiovascular disease (ASCVD). Provider perceptions and prescribing practices of statins vary. Internal medicine housestaff (HS) perceptions of statins and new ACC/AHA cholesterol guidelines have not previously been assessed. Methods: We examined internal medicine HS perceptions of statins and ACC/AHA cholesterol guidelines through a 48-question survey. We surveyed HS at three academic training programs. Anonymous responses were collected via a secure website. Results: 99 respondents’ results (84% categorical residents) were examined from Emory, Johns Hopkins, and UTSW. HS report observing low rates of statin side effects: 64% and 91% reported rates of <3% and <10%. Majority of side effects were myalgias (69%), transaminitis (23%), and gastrointestinal symptoms (5%). Over half (54%) of respondents check transaminases prior to statin therapy. If transaminitis >1-2x upper limit of normal (ULN) develop only 6% of residents stop statin therapy, though 62% stop therapy if transaminitis >3x ULN. In stable liver disease, 13% use non-statin therapy. Most residents (73%) agree that patients understand why they are prescribed statins and feel compliance is influenced by experienced/perceived risk of side effects (44%), cost (30%), and medical benefit (13%). However, HS do not discuss side effects in 25% of patients and only 44% agree patients frequently ask about side effects. Additionally, only 51% of HS discuss ASCVD risk with a majority of patients. HS perceive high rates of statin adherence (87% state >50% adherence at one year). Of 61 HS, 72% learned of new lipid guidelines through residency training. Nearly all (89%) read a portion of the guidelines and are likely to implement them (97%). However, only 57% agree the guidelines are clear or straightforward to apply in clinical practice and 66% agreed the guidelines will improve/reduce ASCVD risk. Only 48% agree new guidelines will improve quality of patient care. Conclusion: Practice patterns of statin therapy vary among medicine HS. Side effects and ASCVD risk are not frequently discussed with patients. Though HS are aware of new cholesterol guidelines, a gap exists between implementation and perceived benefits/ASCVD risk reduction.

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Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

Journal of the American Heart Association ◽

10.1161/jaha.120.017487 ◽

2021 ◽

Author(s):

Matthew J. Czarny ◽

Rani K. Hasan ◽

Wendy S. Post ◽

Matthews Chacko ◽

Stefano Schena ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Black Race ◽

Transcatheter Aortic Valve ◽

Black Patients ◽

Hispanic Patients ◽

White Patients

Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P <0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P <0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P =0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P <0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P <0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P =0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.

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Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

Reviews in Health Care ◽

10.7175/rhc.v7i1.1263 ◽

2016 ◽

Vol 7 (1) ◽

pp. 17-25

Author(s):

Cezary Wójcik

Keyword(s):

Statin Therapy ◽

Heart Association ◽

Lipid Lowering ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Lowering Therapy ◽

Pcsk9 Inhibitors ◽

Level Of Evidence ◽

Cholesterol Guidelines ◽

Pcsk9 Inhibition ◽

Current Guidelines

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

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Prognostic impact of cascade screening for familial hypercholesterolemia on cardiovascular events

European Heart Journal ◽

10.1093/ehjci/ehaa946.2983 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Tada ◽

H Okada ◽

A Nomura ◽

A Nohara ◽

M Yamagishi ◽

...

Keyword(s):

Risk Factors ◽

Familial Hypercholesterolemia ◽

Cardiovascular Events ◽

Lipid Lowering ◽

Funding Source ◽

Atherosclerotic Cardiovascular Disease ◽

Prognostic Impact ◽

Cascade Screening ◽

Ascvd Risk ◽

The Impact

Abstract Background Early diagnosis and timely treatment for the patients with familial hypercholesterolemia (FH) can substantially lower the risk of atherosclerotic cardiovascular disease (ASCVD). In this sense, cascade screening could be one of the most useful options. However, few data exist regarding the impact of cascade screening for FH on the reduction of risk of ASCVD events. Objectives We aimed to evaluate the prognostic impact of cascade screening for FH. Methods We retrospectively investigated the health records of 1,050 patients with clinically diagnosed FH, including probands and their relatives who were cascade-screened. We used Cox models that were adjusted for established ASCVD risk factors to assess the association between cascade screening and major adverse cardiovascular events (MACE). The median period of follow-up was 12.3 years (interquartile range [IQR] = 9.1–17.5 years), and MACE included death from any causes or hospitalization due to ASCVD events. Results During the observation period, 246 participants experienced MACE. The mean age of patients identified through cascade screening was 18-years younger than that of the probands (38.7 yr vs. 57.0 yr, P<0.001), with a lower proportion of ASCVD risk factors. Interestingly, patients identified through cascade screening under milder lipid-lowering therapies were at reduced risk for MACE (hazard ratio [HR] = 0.36; 95% CI = 0.22 to 0.60; P<0.001) when compared with the probands, even after adjusting for those known risk factors. Conclusions The identification of patients with FH via cascade screening appeared to result in better prognoses. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Scientific research grants from the Ministry of Education, Science and Culture of Japan (no. 16K19394, 18K08064, and 19K08575)

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