Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry. (December 2017)

• Record Type: Journal Article
• Authors: Amrock, Stephen M.; Duell, P. Barton; Knickelbine, Thomas; Martin, Seth S.; O'Brien, Emily C.; Watson, Karol E.; Mitri, Joanna; Kindt, Iris; Shrader, Peter; Baum, Seth J.; Hemphill, Linda C.; Ahmed, Catherine D.; Andersen, Rolf L.; Kullo, Iftikhar J.; McCann, Dervilla; Larry, John A.; Murray, Michael F.; Fishberg, Robert; Guyton, John R.; Wilemon, Katherine; Roe, Matthew T.; Rader, Daniel J.; Ballantyne, Christie M.; Underberg, James A.; Thompson, Paul; Duffy, Dannielle; Linton, MacRae F.; Shapiro, Michael D.; Moriarty, Patrick M.; Knowles, Joshua W.; Ahmad, Zahid S.;
• Is Part Of: Atherosclerosis. Volume 267(2017)
• Page Start: 19
• Page End: 26
• Publication Date: 2017-12
• Subjects: Familial hypercholesterolemia -- Hyperlipidemia -- Disparities -- Race -- Ethnicity -- Sex; ASCVD atherosclerotic cardiovascular disease -- FH familial hypercholesterolemia -- LDL-C low-density lipoprotein cholesterol -- PCSK9 proprotein convertase subtilisin/kexin type 9; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2017.10.006
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Most familial hypercholesterolemia (FH) patients remain undertreated, and it is unclear what role health disparities may play for FH patients in the US. We sought to describe sex and racial/ethnic disparities in a national registry of US FH patients. Methods: We analyzed data from 3167 adults enrolled in the CAscade SCreening for Awareness and DEtection of Familial Hypercholesterolemia (CASCADE-FH) registry. Logistic regression was used to evaluate for disparities in LDL-C goals and statin use, with adjustments for covariates including age, cardiovascular risk factors, and statin intolerance. Results: In adjusted analyses, women were less likely than men to achieve treated LDL-C of <100 mg/dL (OR 0.68, 95% CI, 0.57–0.82) or ≥50% reduction from pretreatment LDL-C (OR 0.79, 95% CI, 0.65–0.96). Women were less likely than men to receive statin therapy (OR, 0.60, 95% CI, 0.50–0.73) and less likely to receive a high-intensity statin (OR, 0.60, 95% CI, 0.49–0.72). LDL-C goal achievement also varied by race/ethnicity: compared with whites, Asians and blacks were less likely to achieve LDL-C levels <100 mg/dL (Asians, OR, 0.47, 95% CI, 0.24–0.94; blacks, OR, 0.49, 95% CI, 0.32–0.74) or ≥50% reduction from pretreatment LDL-C (Asians, OR 0.56, 95% CI, 0.32–0.98; blacks, OR 0.62, 95% CI, 0.43–0.90). Conclusions: In a contemporary US population of FH patients, we identified differences in LDL-C goal attainment and statin usage after stratifying the population by either sex or race/ethnicity. Our findings suggest that health disparities contribute to the undertreatment of US FH patients. Increased efforts are warranted to raise awareness of these disparities. Highlights: Disparities by sex and race/ethnicity were noted in US lipid clinics. Women were less likely than men to achieve LDL-C goals and to receive statins. Asians and blacks were 40–50% less likely to achieve LDL-C goals than whites.