Abstract 035: Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among Individuals With Familial Hypercholesterolemia in the U.S. (1999-2014)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Emily M Bucholz ◽  
Angie M Rodday ◽  
Katherine Kolor ◽  
Muin Khoury ◽  
Sarah D deFerranti
Keyword(s):  
Statin Therapy ◽  
Familial Hypercholesterolemia ◽  
High Intensity ◽  
Statin Treatment ◽  
Usual Source Of Care ◽  
Uninsured Patients ◽  
Cholesterol Screening ◽  
Source Of Care ◽  
The U.S ◽  
Statin Use

Background: Familial hypercholesterolemia (FH) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD); however, recent data from ambulatory care centers suggests that prescription rates for statins remain low in patients with severe dyslipidemia or diagnosed FH. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. Methods: Data from the 1999 to 2014 National Health and Nutrition Examination Survey (NHANES) were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among U.S. adults ≥20 years of age (n=42,471 weighted to represent 212 million U.S. adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol (LDL-C) levels ≥190mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. Results were extrapolated to the U.S. adult population. Results: The US prevalence of definite/probable FH was 0.47% (standard error 0.03%) and of severe dyslipidemia was 6.59% (SE 0.17%). Rates of cholesterol screening and awareness were high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% (SE 8.2%) of adults with definite/probable FH and 37.6% (SE 1.2%) of adults with severe dyslipidemia). Less than half of those on statins were prescribed a high-intensity statin. The prevalence of statin use in adults with definite/probable FH and severe dyslipidemia increased slightly over time but not faster than trends in the general population. Older age, insurance, having a usual source of care, diabetes, hypertension, and having a personal history of early ASCVD were associated with statin use. The discrepancy between cholesterol screening and treatment rates was most pronounced in younger patients, uninsured patients, and patients without a usual source of care. Conclusions: Despite high rates of cholesterol screening and awareness, only about half of U.S adults with FH are on statin therapy and even fewer are prescribed a high-intensity statin; young and uninsured patients are at the highest risk for under treatment. A low rate of statin use in young adults is of particular relevance given the early onset of ASCVD in adults with FH. This study highlights an opportunity and an imperative to improve statin treatment rates in this high-risk population. Additional studies are needed to better understand how to close the gap between screening and treatment among adults with FH and improve treatment rates among those with limited access to care.

Abstract 12169: LDL-C Levels and Treatment Patterns Among Adults With Heterozygous Familial Hypercholesterolemia in the United States: Data From the CASCADE-FH Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emil M deGoma ◽  
Zahid S Ahmad ◽  
Emily O'Brien ◽  
Iris Kindt ◽  
Peter Shrader ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Familial Hypercholesterolemia ◽  
High Intensity ◽  
The United States ◽  
Treatment Patterns ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cascade Screening ◽  
Cross Sectional ◽  
Lowering Therapy ◽  
Care Gaps

Introduction: In the US, LDL-C levels and treatment patterns of patients with familial hypercholesterolemia (FH) – a group prioritized for statin therapy in the 2013 ACC/AHA cholesterol guidelines – remain poorly described. In 2013 the FH Foundation launched the CAscade SCreening for Awareness and DEtection (CASCADE) of FH Registry, the only active US FH patient registry addressing this knowledge gap. Methods: We conducted a 2-year (2013-2015) cross-sectional analysis among 1,295 adults with heterozygous FH enrolled in the CASCADE FH Registry from 10 US lipid clinics. Results: Mean (SD) age at enrollment was 54 (16) years; mean age at FH diagnosis was 45 (19) years; 59% were female; and 80% were white. Mean pretreatment and post-treatment LDL-C levels were 256 (66) and 156 (71) mg/dl, respectively. At enrollment, 43% of patients were taking high-intensity statin therapy; 25% were not taking a statin; and 45% received >1 LDL-lowering therapy. Among FH patients on LDL-lowering therapy, 25% achieved an LDL-C <100 mg/dl, and 41% achieved a ≥50% LDL-C reduction (Table). Factors associated with a ≥50% LDL-C reduction included high-intensity statin use (adjusted OR 2.24, 95% CI 1.47-3.42) and use of >1 LDL-lowering therapy (1.94, 1.29-2.93) (Figure). Atherosclerotic cardiovascular disease (ASCVD) was present in 37%, of whom 44% achieved a ≥50% LDL-C reduction and 9% achieved an LDL-C <70 mg/dl. Conclusions: Despite the high prevalence of ASCVD, several care gaps exist for FH patients enrolled in the CASCADE US registry: lack of early diagnosis, insufficient use of high-intensity statin therapy, and failure to achieve adequate LDL-C reductions.

scholarly journals An insight into statin use and its association with muscular side effects in clinical practice

2015 ◽  
Vol 53 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Andreea Farcas ◽  
Camelia Bucsa ◽  
D. Leucuta ◽  
Cristina Mogosan ◽  
M. Bojita ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Side Effects ◽  
Statin Therapy ◽  
Prospective Observational Study ◽  
Muscle Power ◽  
Statin Treatment ◽  
Lower Limbs ◽  
Time To Onset ◽  
Insight Into ◽  
Statin Use

Abstract Background. Muscular complaints are known side-effects of statin therapy, ranging from myalgia to clinically important myositis and rhabdomyolysis. We investigated the statin use and association with the presence and characteristics of muscular complaints. Methods. We conducted a prospective observational study in internal medicine departments. Patients with statin therapy before hospitalization were interviewed for muscular complaints. When muscular complaints were reported, information on type and severity of muscular symptoms, location and time to onset was collected. Results. We identified 85 patients with statin treatment at hospital admission out of 521 included. Nine (10.59%) patients reported muscular complaints associated with statin therapy. A cluster of symptoms (cramps, stiffness, decreased muscle power) was reported, affecting both upper and lower limbs. The severity of pain was in most of the cases moderate or severe. All patients reported that pain was intermittent. Five reported that pain was generalized. Symptoms appeared in the first month of treatment or three months after the drug initiation. Creatine kinase was raised in one patient. In two cases drug interactions were probably responsible for muscular complaints. Conclusion. In the studied set of patients muscular symptoms were a rather frequent effect of statin therapy. As this side-effect could be troublesome for patients and could lead to more severe outcomes, their timely detection and management is important.

scholarly journals Long-term lipoprotein apheresis in the treatment of severe familial hypercholesterolemia refractory to high intensity statin therapy: Three year experience at a lipoprotein apheresis centre

2020 ◽  
Vol 26 (6) ◽  
pp. 669-679 ◽  
Author(s):  
Agnieszka Mickiewicz ◽  
Justyna Borowiec-Wolna ◽  
Witold Bachorski ◽  
Natasza Gilis-Malinowska ◽  
Rafał Gałąska ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Familial Hypercholesterolemia ◽  
High Intensity ◽  
Lipoprotein Apheresis

scholarly journals Improved COVID-19 Outcomes following Statin Therapy: An Updated Systematic Review and Meta-analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-20
Author(s):  
Amir Vahedian-Azimi ◽  
Seyede Momeneh Mohammadi ◽  
Maciej Banach ◽  
Farshad Heidari Beni ◽  
Paul C. Guest ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Statin Therapy ◽  
Disease Transmission ◽  
Statistical Power ◽  
Meta Analysis ◽  
Random Effect ◽  
Statin Treatment ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Statin Use

Background. Although vaccine rollout for COVID-19 has been effective in some countries, there is still an urgent need to reduce disease transmission and severity. We recently carried out a meta-analysis and found that pre- and in-hospital use of statins may improve COVID-19 mortality outcomes. Here, we provide an updated meta-analysis in an attempt to validate these results and increase the statistical power of these potentially important findings. Methods. The meta-analysis investigated the effect of observational and randomized clinical studies on intensive care unit (ICU) admission, tracheal intubation, and death outcomes in COVID-19 cases involving statin treatment, by searching the scientific literature up to April 23, 2021. Statistical analysis and random effect modeling were performed to assess the combined effects of the updated and previous findings on the outcome measures. Findings. The updated literature search led to the identification of 23 additional studies on statin use in COVID-19 patients. Analysis of the combined studies ( n = 47 ; 3,238,508 subjects) showed no significant effect of statin treatment on ICU admission and all-cause mortality but a significant reduction in tracheal intubation ( OR = 0.73 , 95% CI: 0.54-0.99, p = 0.04 , n = 10 studies). The further analysis showed that death outcomes were significantly reduced in the patients who received statins during hospitalization ( OR = 0.54 , 95% CI: 0.50-0.58, p < 0.001 , n = 7 studies), with no such effect of statin therapy before hospital admission ( OR = 1.06 , 95% CI = 0.82 -1.37, p = 0.670 , n = 29 studies). Conclusion. Taken together, this updated meta-analysis extends and confirms the findings of our previous study, suggesting that in-hospital statin use leads to significant reduction of all-cause mortality in COVID-19 cases. Considering these results, statin therapy during hospitalization, while indicated, should be recommended.

scholarly journals The effect of loading dose of rosuvastatin on peri-procedural myocardial infarction

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
UY Sinan ◽  
B Keskin ◽  
E Serin ◽  
A Arat-Ozkan
Keyword(s):  
Myocardial Infarction ◽  
Statin Therapy ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Statin Treatment ◽  
Control Group ◽  
High Dose ◽  
Loading Dose ◽  
Funding Sources ◽  
Statin Use

Abstract Funding Acknowledgements Type of funding sources: None. Objectives The aim of this study is to investigate the effect of rosuvastatin loading dose on peri-procedural myocardial infarction (PPMI) and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing elective PCI according to their statin use. Background High-dose statin therapy before PCI is thought to reduce the occurrence of PPMI, which is known to be associated with increased mortality and prolonged hospitalization, especially in statin naïve patients. Methods   One hundred sixty-five patients were included in the study and divided into two groups as patients already on statin treatment (n:126) and statin naive patients (n:39). Both groups were randomly assigned to high-dose (40 mg) rosuvastatin (n:86) or control group (n:79). The primary endpoint was the incidence of peri-procedural myocardial infarction, and the secondary endpoint was MACCE.  Results There was 30 patients (19 in high dose statin group, and 11 in control group) diagnosed as PPMI after percutaneous coronary intervention (PCI).  Loading dose of statin therapy did not prohibit occurrence of PPMI. A positive correlation between PPMI and creatinine (r:0.199, p:0.011), lesion complexity (r:0.189, p:0.015) and negative correlation between GFR and PPMI (r:-0.158 p:0,043) was remarkable.  Conclusions Pre-procedural administration of high dose rosuvastatin in patients with stable coronary artery disease has failed to decrease PPMI independent of chronic statin use. Table 1. Termβ estimates with standard errorsORp valueConstant (β0)0.656 ± 1.122-0.559Lesion type (β1)1.224 ± 0.4453.4010.006Gfr (β2)-0.031 ± 0.0130.9700.015GFR and lesion type relationships with peri-procedural MI

Abstract 118: Are Patients with Atherosclerotic Cardiovascular Disease Receiving Appropriate Lipid Management? Insights from the PALM Registry

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Ann M Navar ◽  
Eric D Peterson ◽  
Shuang Li ◽  
Salim S Virani ◽  
Peter W Wilson ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cerebrovascular Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Lipid Management ◽  
Factors Associated ◽  
Lipid Guidelines ◽  
Male Sex ◽  
Statin Use

Background: Prior ATPIII lipid guidelines recommended statin therapy for patients with clinical ASCVD to achieve low density lipoprotein cholesterol (LDL-C) targets, while the 2013 ACC/AHA lipid guidelines recommend high-intensity statin therapy for all ASCVD patients. How closely these recommendations are followed in routine clinical practice is unknown. Methods: We evaluated statin use, intensity, and LDL-C values in 1,483 patients with ASCVD (coronary heart disease, cerebrovascular disease, and peripheral arterial disease) enrolled and seen serially at 62 geographically dispersed US cardiology and primary care clinics in the Patient and Provider Assessment of Lipid Management (PALM) Registry between May - September 2015. Factors associated with high intensity statin use (atorvastatin ≥40 mg or rosuvastatin ≥20 mg daily) and LDL-C <70 mg/dL were evaluated in multivariable logistic regression. Results: Of 1,483 ASCVD patients, 86.2% were on a statin, but only 31.4% were on a high-intensity statin. Overall, 64.0% had an LDL-C <100 mg/dL, but only 29.0% had an LDL-C <70 mg/dL. Factors associated with high-intensity statin use in multivariable regression were younger age (OR 0.74 per 10 year increase, p<0.001, 95% CI 0.66-0.83), male sex (OR 1.69, p<0.001, 95% CI, 1.32-2.16), cerebrovascular disease (OR 1.55, p=0.008, 95% CI 1.12-2.13), coronary heart disease (OR 2.42, p<0.001, 95% CI 1.67-3.50), and being seen by a cardiologist (OR 1.35, p =0.04, 95% CI 1.01-1.81). Factors associated with an increased likelihood of LDL-C<70 were male sex (OR 1.55, p=0.001, 95% CI 1.20-2.01), white (OR 1.62, p=0.03, 95% CI 1.04-2.5-, diabetes (OR 1.64, p<0.001, 95% CI 1.29-2.09) and being seen by a cardiologist (OR 1.94, p<0.001, 95% CI 1.41-2.67). Discussion: Substantial gaps in care remain for secondary prevention of ASCVD despite simplified recommendations. While the majority of patients with ASCVD in community practice are on a statin, only one-third are on high intensity statins and over two-thirds have LDL ≥70 mg/dL.

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

Circulation ◽  
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

scholarly journals Factors Associated with the Prescribing of High-Intensity Statins

2020 ◽  
Vol 9 (12) ◽  
pp. 3850
Author(s):  
Armando Chaure-Pardos ◽  
Sara Malo ◽  
María José Rabanaque ◽  
Federico Arribas ◽  
Belén Moreno-Franco ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Management Practices ◽  
Characteristic Curve ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Moderate Intensity ◽  
Physically Active ◽  
Logistic Regression Models

In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as “high-intensity” or “low–moderate-intensity”. Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08–2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29–19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574–0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins.

Sign in / Sign up

Export Citation Format

Share Document