The Poor State of LDL Cholesterol Management in the US

The Poor State of LDL Cholesterol Management in the US

Breaking Down the Latest Family Heart Foundation Research

This week, the Family Heart Foundation team will present important new research at the 2023 American College of Cardiology Scientific Sessions in New Orleans. This analysis from the Family Heart DatabaseTM examines the state of LDL cholesterol management in 38 million Americans at high risk for cardiovascular disease. Ultimately, this research highlights a glaring gap in American healthcare. Let’s break it down to get the whole picture.

In 2018, The American College of Cardiology, the American Heart Association, and 10 other medical societies published a guideline for the management of cholesterol. It says that high low-density lipoprotein (LDL) cholesterol is a “primary cause of atherosclerosis” that leads to cardiovascular disease, heart attack, stroke, and even death. It states that high-risk individuals with existing atherosclerotic cardiovascular disease (ASCVD) should aim to get their LDL cholesterol under 70 mg/dL. For those in the general population who don’t have ASCVD should aim for 100 mg/dL.

So we asked the question – is that happening in America? Is our system following these guidelines when caring for the most at-risk patients?

We used real-world data from the Family Heart DatabaseTM which is a database of medical claims and laboratory data covering more than half the US population. Information is anonymous and gives us insight into current trends in medical care. Here’s what we found:

Of more than 38 million Americans at the highest risk of heart disease, 72% never reach recommended LDL cholesterol levels. 

Patients at the highest risk are those with LDL cholesterol levels higher than 190 mg/dL or existing ASCVD. This group includes those with familial hypercholesterolemia (FH) or homozygous familial hypercholesterolemia (HoFH).

Not only are 72% not reaching recommended LDL cholesterol levels, but many of them are also not on any lipid-lowering treatment at all. None. Many that are on one treatment are still not lowering their LDL cholesterol to the recommended level.

In essence, 72% of high-risk Americans that are in danger – like walking into oncoming traffic – and don’t know it. That number represents people who may leave their families behind too young – people who will miss holidays, weddings, birthdays, and all the life celebrations we spend with the most important people in our lives.

With the many safe and effective lipid-lowering treatments available today, these families don’t have to lose the ones they love.

Those who do reach their LDL cholesterol safe zone only stay there for an average of less than 6 months at a time.

When high-risk patients do get their LDL down, they keep it there for an average of 159 days at a time. Research indicates that the longer someone’s LDL is low, the better. Unfortunately, there are many reasons for people to stop taking their medications – insurance problems, cost, side effects, or the belief that once they get where they need to be, they don’t need medicine anymore.

80% of clinicians never prescribe combination lipid-lowering drugs.

When we say, “combination therapy,” we mean taking more than one medication or treatment to control LDL cholesterol levels. Statins are typically the first line of defense and treatment is built upon that.

The highest-risk patients in America, especially those with FH, will often need combination therapy because a statin alone doesn’t get them to their recommended safe zone. What we’re seeing is clinicians, for any number of reasons, are not using more than one drug to treat high-risk patients.

Only 2% of patients ever receive combination lipid-lowering drugs.

When healthcare providers don’t prescribe combination therapy, many may miss out on the care their need.

Not everyone needs combination therapy to control their LDL cholesterol, but it is safe to say more than 2% would benefit from using more than one of the many safe and effective treatment options available today.

“This study provides us with a clear view of the poor state of LDL-cholesterol management for high-risk individuals in the United States. Despite the availability of safe and effective lipid-lowering therapies, only 28% of high-risk patients ever reach below guideline LDL-C thresholds, which further elevates these patients’ risks for atherosclerotic cardiovascular disease (ASCVD) events, such as heart attacks and stroke.” - Mary P. McGowan, M.D., Chief Medical Officer, Family Heart Foundation, and co-author of the study

Nearly five years after guidelines were released and 35 years after the first statin became available, we’re still not there. We’re not even close.

In the United States, someone dies from cardiovascular disease every 34 seconds. Deaths from heart attack and stroke are increasing, not decreasing. If we are going to reverse that trend, we need everyone working together. Patients, doctors, nurses, health insurance companies, pharmacists, policy makers – we can all write a happier ending to this story.

The Family Heart Foundation is proud to engage with all of these stakeholders in 2023 to identify practical solutions to save more families and more hearts.

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