Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry

Stephen M. Amrock, P. Barton Duell, Thomas Knickelbine, Seth S. Martin, Emily C. O'Brien, Karol E. Watson, Joanna Mitri, Iris Kindt, Peter Shrader, Seth J. Baum, Linda C. Hemphill, Catherine D. Ahmed, Rolf L. Andersen, Iftikhar J. Kullo, Dervilla McCann, John A. Larry, Michael F. Murray, Robert Fishberg, John R. Guyton, Katherine Wilemon & 11 others Matthew T. Roe, Daniel J. Rader, Christie M. Ballantyne, James A. Underberg, Paul Thompson, Dannielle Duffy, MacRae F. Linton, Michael D. Shapiro, Patrick M. Moriarty, Joshua W. Knowles, Zahid S. Ahmad

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalAtherosclerosis
Volume267
DOIs
StatePublished - Dec 1 2017

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Hyperlipoproteinemia Type II
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Registries
Health
Population
Logistic Models
oxidized low density lipoprotein

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Amrock, Stephen M. ; Duell, P. Barton ; Knickelbine, Thomas ; Martin, Seth S. ; O'Brien, Emily C. ; Watson, Karol E. ; Mitri, Joanna ; Kindt, Iris ; Shrader, Peter ; Baum, Seth J. ; Hemphill, Linda C. ; Ahmed, Catherine D. ; Andersen, Rolf L. ; Kullo, Iftikhar J. ; McCann, Dervilla ; Larry, John A. ; Murray, Michael F. ; Fishberg, Robert ; Guyton, John R. ; Wilemon, Katherine ; Roe, Matthew T. ; Rader, Daniel J. ; Ballantyne, Christie M. ; Underberg, James A. ; Thompson, Paul ; Duffy, Dannielle ; Linton, MacRae F. ; Shapiro, Michael D. ; Moriarty, Patrick M. ; Knowles, Joshua W. ; Ahmad, Zahid S. / Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry. In: Atherosclerosis. 2017 ; Vol. 267. pp. 19-26.
@article{1c26acbe407b4eb0b9a6a198110f59eb,
title = "Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry",
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.",
author = "Amrock, {Stephen M.} and Duell, {P. Barton} and Thomas Knickelbine and Martin, {Seth S.} and O'Brien, {Emily C.} and Watson, {Karol E.} and Joanna Mitri and Iris Kindt and Peter Shrader and Baum, {Seth J.} and Hemphill, {Linda C.} and Ahmed, {Catherine D.} and Andersen, {Rolf L.} and Kullo, {Iftikhar J.} and Dervilla McCann and Larry, {John A.} and Murray, {Michael F.} and Robert Fishberg and Guyton, {John R.} and Katherine Wilemon and Roe, {Matthew T.} and Rader, {Daniel J.} and Ballantyne, {Christie M.} and Underberg, {James A.} and Paul Thompson and Dannielle Duffy and Linton, {MacRae F.} and Shapiro, {Michael D.} and Moriarty, {Patrick M.} and Knowles, {Joshua W.} and Ahmad, {Zahid S.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.atherosclerosis.2017.10.006",
language = "English (US)",
volume = "267",
pages = "19--26",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

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Amrock, SM, Duell, PB, Knickelbine, T, Martin, SS, O'Brien, EC, Watson, KE, Mitri, J, Kindt, I, Shrader, P, Baum, SJ, Hemphill, LC, Ahmed, CD, Andersen, RL, Kullo, IJ, McCann, D, Larry, JA, Murray, MF, Fishberg, R, Guyton, JR, Wilemon, K, Roe, MT, Rader, DJ, Ballantyne, CM, Underberg, JA, Thompson, P, Duffy, D, Linton, MF, Shapiro, MD, Moriarty, PM, Knowles, JW & Ahmad, ZS 2017, 'Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry', Atherosclerosis, vol. 267, pp. 19-26. https://doi.org/10.1016/j.atherosclerosis.2017.10.006

Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry. / Amrock, Stephen M.; Duell, P. Barton; Knickelbine, Thomas; Martin, Seth S.; O'Brien, Emily C.; Watson, Karol E.; Mitri, Joanna; Kindt, Iris; Shrader, Peter; Baum, Seth J.; Hemphill, Linda C.; Ahmed, Catherine D.; Andersen, Rolf L.; Kullo, Iftikhar J.; McCann, Dervilla; Larry, John A.; Murray, Michael F.; Fishberg, Robert; Guyton, John R.; Wilemon, Katherine; Roe, Matthew T.; Rader, Daniel J.; Ballantyne, Christie M.; Underberg, James A.; Thompson, Paul; Duffy, Dannielle; Linton, MacRae F.; Shapiro, Michael D.; Moriarty, Patrick M.; Knowles, Joshua W.; Ahmad, Zahid S.

In: Atherosclerosis, Vol. 267, 01.12.2017, p. 19-26.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry

AU - Amrock, Stephen M.

AU - Duell, P. Barton

AU - Knickelbine, Thomas

AU - Martin, Seth S.

AU - O'Brien, Emily C.

AU - Watson, Karol E.

AU - Mitri, Joanna

AU - Kindt, Iris

AU - Shrader, Peter

AU - Baum, Seth J.

AU - Hemphill, Linda C.

AU - Ahmed, Catherine D.

AU - Andersen, Rolf L.

AU - Kullo, Iftikhar J.

AU - McCann, Dervilla

AU - Larry, John A.

AU - Murray, Michael F.

AU - Fishberg, Robert

AU - Guyton, John R.

AU - Wilemon, Katherine

AU - Roe, Matthew T.

AU - Rader, Daniel J.

AU - Ballantyne, Christie M.

AU - Underberg, James A.

AU - Thompson, Paul

AU - Duffy, Dannielle

AU - Linton, MacRae F.

AU - Shapiro, Michael D.

AU - Moriarty, Patrick M.

AU - Knowles, Joshua W.

AU - Ahmad, Zahid S.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

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DO - 10.1016/j.atherosclerosis.2017.10.006

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JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

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