A nationally representative, cross-sectional study published in Circulation highlighted the importance of cholesterol screening and statin prescription in patients with familial hypercholesterolemia (FH) and other forms of severe dyslipidemia. It was found that despite the high prevalence of cholesterol screening and awareness, only ≈50% of adults with FH are on statin therapy, with even fewer prescribed a high-intensity statin.
This study was designed to estimate the prevalence of self-reported screening, awareness, and statin therapy among US adults with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol levels ≥190 mg/dL). Sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy were identified. The primary outcome was current statin use. The estimated US prevalence of definite or probable FH was 0.47% and of severe dyslipidemia was 6.6%.
Using data from the 1999 to 2014 National Health and Nutrition Examination Survey (N=42471), Dr. Bucholz and her colleagues, demonstrated a high prevalence of screening and awareness (>80%) but relatively low rates of statin use (52.3%) among individuals with FH and even lower in those with severe dyslipidemia (37.6%). The discrepancy between the prevalence of cholesterol screening and treatment was most pronounced in younger patients, uninsured patients, and patients without a usual source of health care. Only 30.3% of patients with definite or probable FH who received statins were taking a high-intensity statin therapy. The prevalence of statin use in adults with severe dyslipidemia increased over time (from 29.4% to 47.7%) at a similar rate to the trend in the general population (from 5.7% to 17.6%).
Young and uninsured patients are at the highest risk for lack of screening and for under-treatment. Older age, health insurance status, having a usual source of care, diabetes mellitus, hypertension, and having a personal history of early atherosclerotic cardiovascular disease were associated with higher statin use. Given the cardiovascular morbidity and mortality associated with FH and other severe dyslipidemias and the benefits of statin therapy among such patients, current rates of statin therapy in US adults with FH or severe dyslipidemia were surprisingly low.