Abstract Body: Severe Hypercholesterolemia phenotype (SHP), defined as having low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, is a strong predictor for atherosclerotic cardiovascular artery disease (ASCVD). People diagnosed with SHP are recommended to start taking statins, however there are still gaps and disparities in treatment. The purpose of this study is to characterize SHP patients and describe treatment patterns using real-world data from electronic health records (EHR) at a large academic health system.
We conducted a retrospective cohort study using EHR data of individuals who had a clinical encounter at the University of Wisconsin Hospitals and Clinics between 01/01/2013 and 07/30/2023. The study was approved by the University of Wisconsin-Madison IRB. Participants aged 18–55 years with elevated total cholesterol (>200 mg/dL) or LDL-C (≥130 mg/dL) were eligible for this study. Cases of secondary hypercholesterolemia and participants receiving statins at enrollment were excluded. Statistical analysis was conducted using Pearson’s chi-square and Student t-test and counts (%) for categorical and median (interquartile range) for continuous variables are reported. All analyses were done using R (v. 4.3.1) analytical software.
This study included 33,418 participants, of which 43% were women, 86% were White, and 95% were non-Hispanic/Latino. SHP was identified in 2,822 participants, who tended to be male (61% vs. 54%, P < 0.001), have a personal (2.1% vs. 1.6%, P=0.02) or family (15.6% vs. 11.7%, P < 0.001) history of coronary artery disease, and higher all-cause mortality (1.0% vs. 0.6%, P =0.03), compared to non-SHP cohort. Statin prescription was lower among patients who were younger (median age: 40 vs. 43 years) or Hispanic/Latino (4.6% vs. 2.9%, P = 0.023), with some differences (statistically non-significant) across races. We noted that patients prescribed statins were more likely to have comorbidities – ASCVD (12.2% vs. 3.3%, P < 0.001), hypertension (24.4% vs. 14.6%, P < 0.001), or diabetes (9.1% vs. 4.5%, P < 0.001), compared to their untreated counterparts.
Current study revealed that statin prescription was correlated with age and presence of comorbidities. Our results suggest need for further investigation of institutional, clinician, and patient-related predictors and barriers for statin prescription, to improve compliance with clinical guidelines for prevention of ASCVD and other SHP-related diseases.