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.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Groth NA,Stone NJ,Benziger CPdoi
10.1002/clc.23521subject
Has Abstractpub_date
2020-12-23 00:00:00eissn
0160-9289issn
1932-8737pub_type
杂志文章abstract::Three cases are presented where acute myocardial infarction occurred in young individuals after an episode of heavy alcohol intake. Subsequent coronary arteriograms demonstrated normal coronary arteries. Several mechanisms by which acute ethanol intoxication might precipitate myocardial infarction are discussed. To ou...
journal_title:Clinical cardiology
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