Statin treatment and LDL-cholesterol treatment goal attainment among individuals with familial hypercholesterolaemia in UK Primary Care

Problem

The National Institute for Health and Care Excellence guidelines in England recommend that statin treatment for individuals with Familial Hypercholesterolaemia (FH) should aim for at least a 50% reduction in low density lipoprotein cholesterol (LDL-C) from the baseline measurement. Here, we assessed statin prescribing rates as well as the LDL-cholesterol treatment goal attainment among individuals with FH in primary care.

Approach

Using electronic health records from the UK Clinical Practice Research Datalink (CPRD), we identified adults with a diagnosis of FH coded in their primary care records, records of statin treatment, measures of LDL-cholesterol prior to the onset of statin treatment (baseline) and repeat measures at 12 months. The percentage change in LDL-cholesterol during the 12-month period of follow-up was determined, and then baseline and treatment characteristics were assessed by LDL-cholesterol treatment goal attainment.

Findings

Of the 3,064 adults (mean age 50.8 years) with primary care diagnosis of FH, the treatment goal of 50% reduction in LDL-cholesterol was attained in only 895 individuals (29.2%). Compared to individuals who failed to attain the 50% LDL-cholesterol reduction from baseline, those who attained the LDL-cholesterol goal reduction were of older age at time of FH diagnosis (53.4 years vs 49.7 years) and at time of first statin treatment (53.2 years vs 49.2 years), they had significantly higher pre-treatment total cholesterol (8.20 (SD 1.38)mmol/l vs 7.57 (SD 1.39)mmol/l) and pre-treatment LDL-cholesterol (5.83 (SD 1.36) mmol vs 5.25 (SD 1.40) mmol/l) at baseline, and a higher proportion of these individuals who attained the treatment goal were prescribed high and medium potency statins (24.3% and 71.7% versus 20.2% and 69.3% respectively).

Consequences

Only a third of individuals on statin treatment for FH in primary care achieve the NICE-recommended treatment goal of 50% reduction in LDL-cholesterol from baseline. This highlights the need for optimisation of statin treatment for individuals with FH in primary care.