Advertisement

Treatment pattern of familial hypercholesterolemia in Slovakia: Targets, treatment and obstacles in common practice

      Highlights

      • A substantial proportion of FH patients are undertreated in Slovakia.
      • Reference of FH patients to specialised clinics leads to improvement in the treatment.
      • The majority of FH patients do not reach LDL-C goal levels despite specialised management.

      Abstract

      Background and aims

      Maximal doses of potent statins are the cornerstone of treatment of familial hypercholesterolemia (FH). Despite this, a substantial proportion of FH patients are either under-treated or not treated at all. The aim of this work was to evaluate, in a retrospective study, the treatment of FH patients, the proportion of FH patients reaching low-density lipoprotein cholesterol (LDL-C) goals, and reasons for not reaching LDL-C goals, in 8 lipid clinics in Slovakia dealing with FH patients.

      Methods

      201 heterozygous FH patients (50.8 ± 14.9 years, 55% females) who attended the lipid clinics at least three times were included in the study.

      Results

      At the first visit, 31.3% of patients were treated with statins and the most common dose was 20 mg of atorvastatin, rosuvastatin and simvastatin. At the third visit, 78.1% of patients were treated with statins and 24.4% with ezetimibe. The majority of patients were treated with atorvastatin (75.8%) and rosuvastatin (18.5%) and 31.3% of all patients were treated with atorvastatin 80 mg or rosuvastatin 40 mg with/without ezetimibe. However, only 11.9% of patients with the LDL-C goal level <2.5 mmol/l and 6.9% with the goal <1.8 mmol/l reached the level. Reasons for not reaching the goal levels were evaluated by physicians in each patient. Insufficient LDL-C lowering effect of treatment, side-effects of therapy and non-compliance of patients were responsible for 46%, 18% and 30% of cases, respectively.

      Conclusions

      Referral of FH patients to lipid clinics in Slovakia leads to improvement in the treatment; however, almost 22% of the patients are still without statin treatment and the majority of patients do not reach the LDL-C goal level.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nordestgaard B.G.
        • Chapman M.J.
        • Humphries S.E.
        • et al.
        European Atherosclerosis Society Consensus Panel. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European atherosclerosis society.
        Eur. Heart J. 2013 Dec; 34: 3478-3490a
        • Akioyamen L.E.
        • Genest J.
        • Shan S.D.
        • Reel R.L.
        • Albaum J.M.
        • Chu A.
        • Tu J.V.
        Estimating the prevalence of heterozygous familial hypercholesterolaemia: a systematic review and meta-analysis.
        Br. Med. J. Open. 2017 Sep 1; 7 (e016461)
        • Versmissen J.
        • Oosterveer D.M.
        • Yazdanpanah M.
        • Defesche J.C.
        • Basart D.C.
        • Liem A.H.
        • Heeringa J.
        • Witteman J.C.
        • Lansberg P.J.
        • Kastelein J.J.
        • Sijbrands E.J.
        Efficacy of statins in familial hypercholesterolaemia: a long term cohort study.
        BMJ. 2008; 337 (a2423)
        • Scientific Steering Committee on behalf of the Simon Broome Register Group
        Mortality in treated heterozygous familial hypercholesterolaemia: implications for clinical management.
        Atherosclerosis. 1999; 142: 105-112
        • Benn M.
        • Watts G.F.
        • Tybjaerg-Hansen A.
        • Nordestgaard B.G.
        Familial hypercholesterolemia in the Danish general population: prevalence, coronary artery disease, and cholesterol-lowering medication.
        J. Clin. Endocrinol. Metab. 2012; 97: 3956-3964
        • Vohnout B.
        • Raslova K.
        • Gasparovic J.
        • Franekova J.
        • Fabryova L.
        • Belosovicova M.
        • Kovac G.
        • Sebova C.
        • Rajecova E.
        • Stavny J.
        • Babjak M.
        • Donati M.B.
        • Iacoviello L.
        Lipid levels and their genetic regulation in patients with familial hypercholesterolemia and familial defective apolipoprotein B-100: the MEDPED Slovakia project.
        Atherosclerosis Suppl. 2003; 4: 3-5
        • Gašparovič J.
        • Bašistová Z.
        • Fábryová Ľ.
        • Wsólová L.
        • Vohnout B.
        • Rašlová K.
        Familial defective apolipoprotein B-100 in Slovakia. Are differences in prevalence of FDB explained by ethnicity?.
        Atherosclerosis. 2007; 194 (e95-107)
        • Civeira F.
        Guidelines for the diagnosis and management of heterozygous familial hypercholesterolemia.
        Atherosclerosis. 2004; 173: 55-68
        • Risk of fatal coronary heart disease in familial hypercholesterolaemia
        Scientific steering committee on behalf of the Simon Broome register group.
        BMJ. 1991; 303: 893-896
        • Williams R.R.
        • Hunt S.C.
        • Schumacher M.C.
        • Hegele R.A.
        • Leppert M.F.
        • Ludwig E.H.
        • Hopkins P.N.
        Diagnosing heterozygous familial hypercholesterolemia using new practical criteria validated by molecular genetics.
        Am. J. Cardiol. 1993; 72: 171-176
        • Gabčová D.
        • Vohnout B.
        • Staníková D.
        • Hučkova M.
        • Kadurová M.
        • Debreová M.
        • Kozárová M.
        • Fábryová L.
        • Slovak F.H.
        • study group
        • Staník J.
        • Klimeš I.
        • Rašlová K.
        • Gašperiková D.
        The molecular genetic background of familial hypercholesterolemia: data from the Slovak nation-wide survey.
        Physiol. Res. 2017; 66: 75-84
        • Catapano A.L.
        • Reiner Z.
        • De Backer G.
        • Graham I.
        • Taskinen M.R.
        • Wiklund O.
        • Agewall S.
        • Alegria E.
        • Chapman M.
        • Durrington P.
        • Erdine S.
        • Halcox J.
        • Hobbs R.
        • Kjekshus J.
        • Filardi P.P.
        • Riccardi G.
        • Storey R.F.
        • Wood D.
        European society of cardiology (ESC); European atherosclerosis society (EAS). ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European society of cardiology (ESC) and the European atherosclerosis society (EAS).
        Atherosclerosis. 2011; 217: 3-46
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of lowdensity lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin. Chem. 1972; 18: 499-502
        • Béliard S.
        • Carreau V.
        • Carrié A.
        • et al.
        Improvement in LDL-cholesterol levels of patients with familial hypercholesterolemia: can we do better? Analysis of results obtained during the past two decades in 1669 French subjects.
        Atherosclerosis. 2014; 234: 136-141
        • Pijlman A.H.
        • Huijgen R.
        • Verhagen S.N.
        • et al.
        Evaluation of cholesterol lowering treatment of patients with Familial hypercholesterolemia: a large cross sectional study in The Netherlands.
        Atherosclerosis. 2010; 209: 189-194
        • Leren T.P.
        • Berge K.E.
        Subjects with molecularly defined familial hypercholesterolemia or familial defective apoB-100 are not being adequately treated.
        PLoS One. 2011; 6 (e16721)
        • Perez de Isla L.
        • Alonso R.
        • Watts G.F.
        • Mata N.
        • Saltijeral Cerezo A.
        • Muñiz O.
        • Fuentes F.
        • Diaz-Diaz J.L.
        • de Andrés R.
        • Zambón D.
        • Rubio-Marin P.
        • Barba-Romero M.A.
        • Saenz P.
        • Sanchez Muñoz-Torrero J.F.
        • Martinez-Faedo C.
        • Miramontes-Gonzalez J.P.
        • Badimón L.
        Mata P; SAFEHEART investigators. Attainment of LDL-cholesterol treatment goals in patients with familial hypercholesterolemia: 5-year SAFEHEART Registry follow-up.
        J. Am. Coll. Cardiol. 2016 Mar 22; 67: 1278-1285
        • Landmesser U.
        • Chapman M.J.
        • Stock J.K.
        • Amarenco P.
        • Belch J.J.F.
        • Borén J.
        • Farnier M.
        • Ference B.A.
        • Gielen S.
        • Graham I.
        • Grobbee D.E.
        • Hovingh G.K.
        • Lüscher T.F.
        • Piepoli M.F.
        • Ray K.K.
        • Stroes E.S.
        • Wiklund O.
        • Windecker S.
        • Zamorano J.L.
        • Pinto F.
        • Tokgözoglu L.
        • Bax J.J.
        • Catapano A.L.
        2017 Update of ESC/EAS Task Force on practical clinical guidance for proprotein convertase subtilisin/kexin type 9 inhibition in patients with atherosclerotic cardiovascular disease or in familial hypercholesterolaemia.
        Eur. Heart J. 2018; 39: 1131-1143