Stephen M Amrock1, P Barton Duell2, Thomas Knickelbine3, Seth S Martin4, Emily C O'Brien5, Karol E Watson6, Joanna Mitri7, Iris Kindt8, Peter Shrader5, Seth J Baum9, Linda C Hemphill10, Catherine D Ahmed11, Rolf L Andersen12, Iftikhar J Kullo13, Dervilla McCann14, John A Larry15, Michael F Murray16, Robert Fishberg17, John R Guyton18, Katherine Wilemon11, Matthew T Roe5, Daniel J Rader19, Christie M Ballantyne20, James A Underberg21, Paul Thompson22, Dannielle Duffy23, MacRae F Linton24, Michael D Shapiro2, Patrick M Moriarty25, Joshua W Knowles26, Zahid S Ahmad27. 1. Department of Medicine, Oregon Health & Science University, Portland, OR, USA. 2. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. 3. Minneapolis Heart Institute Foundation, Minnaepolis, MN, USA. 4. Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. 5. Duke Clinical Research Institute, Durham, NC, USA. 6. UCLA Center for Cholesterol and Lipid Management, Los Angeles, CA, USA. 7. Joslin Diabetes Center, Harvard Medical School Boston, MA, USA. 8. The FH Foundation, Pasadena, CA, USA. 9. Seth J. Baum, MD. Preventive Cardiology Inc., Boca Raton, FL, USA. 10. Massachusetts General Hospital, Boston, MA, USA. 11. The FH Foundation, South Pasadena, CA, USA. 12. Lancaster General Health/Penn Medicine, Lancaster, PA, USA. 13. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. 14. Central Maine Heart and Vascular Institute/Central Maine Medical Center (CMMC), Lewiston ME, USA. 15. The Ohio State University Medical Center, Columbus, OH, USA. 16. Geisinger Health System, Forty Fort, PA, USA. 17. Atlantic Health System, Springfield, NJ, USA. 18. Duke University Medical Center, Durham, NC, USA. 19. University of Pennsylvania, Philadelphia, PA, USA. 20. Baylor College of Medicine, Houston, TX, USA. 21. New York University School of Medicine, New York, NY, USA. 22. Hartford Hospital, Hartford CT, USA. 23. Thomas Jefferson University, Philadelphia, PA, USA. 24. Vanderbilt University School of Medicine, Nashville, TN, USA. 25. University of Kansas Medical Center, Kansas City, KS, USA. 26. The FH Foundation, South Pasadena, CA, USA; Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, USA. 27. Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA. Electronic address: zahid.ahmad@utsouthwestern.edu.
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.
BACKGROUND AND AIMS: Most familial hypercholesterolemia (FH) patients remain undertreated, and it is unclear what role health disparities may play for FHpatients in the US. We sought to describe sex and racial/ethnic disparities in a national registry of US FHpatients. 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 FHpatients, 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 FHpatients. Increased efforts are warranted to raise awareness of these disparities.
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