Cardiology clinic visit increases likelihood of evidence‐based cholesterol prescribing in severe hypercholesterolemia. Issue 2 (23rd December 2020)

• Record Type: Journal Article
• Authors: Groth, Nicole A.; Stone, Neil J.; Benziger, Catherine P.
• Is Part Of: Clinical cardiology. Volume 44:Issue 2(2021)
• Page Start: 186
• Page End: 192
• Publication Date: 2020-12-23
• Subjects: atherosclerotic cardiovascular disease -- guideline adherence -- low‐density lipoprotein cholesterol -- rural healthcare -- severe hypercholesterolemia; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.23521
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract: Background: Patients with phenotypic severe hypercholesterolemia (SH), low‐density lipoprotein‐cholesterol (LDL‐c) ≥ 190 mg/dl, atherosclerotic cardiovascular disease (ASCVD) or adults 40–75 years with diabetes with risk factors or 10‐year ASCVD risk ≥20% benefit from maximally tolerated statin therapy. Rural patients have decreased access to specialty care, potentially limiting appropriate treatment. Hypothesis: Prior visit with cardiology will improve treatment of severe hypercholesterolemia. Methods: We used an electronic medical record‐based SH registry defined as ever having an LDL‐c ≥ 190 mg/dl since January 1, 2000 ( n = 18 072). We excluded 3205 (17.7%) patients not alive or age 20–75 years. Patients defined as not seen by cardiology if they had no visit within the past 3 years (2017–2019). Results: We included 14 867 patients (82.3%; mean age 59.7 ± 10.3 years; 58.7% female). Most patients were not seen by cardiology ( n = 13 072; 72.3%). After adjusting for age, sex, CVD, hypertension, diabetes and obesity, patients seen by cardiology were more likely to have any lipid‐lowering medication (OR = 1.46, 95% CI: 1.29–1.65), high‐intensity statin (OR = 1.81, 95% CI: 1.61–2.03), or proprotein convertase subtilisin‐kexin type 9 (PCSK9) inhibitor (OR = 5.96, 95% CI: 3.34–10.65) compared to those not seen by cardiology. Mean recent LDL‐c was lower in patients seen by cardiology (126.8 ± 51.6 mg/dl vs. 152.4 ± 50.2 mg/dl, respectively; p < .001). Conclusion: In our predominantly rural population, a visit with cardiology improved the likelihood to be prescribed any statin, a high‐intensity statin, or PCSK9 inhibitor. This more appropriately addressed their high life‐time risk of ASCVD. Access to specialty care could improve SH patient's outcomes.