Identifying Undiagnosed or Undertreated Patients with Familial Hypercholesterolemia from the Laboratory Records of a Tertiary Medical Center

Haymana, Cem

doi:10.5543/tkda.2017.63846

Cited by 4 publications

(3 citation statements)

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“…Negative campaigns against statins is a prominent issue for statin cessation in Turkey. In a previous survey, high rates of statin cessation was reported in patients with familial hypercholesterolemia due to the negative environmental effects [42]. The TEMD Dyslipidemia Study is the first nationwide study in Turkey, showing the link between negative news stories and the statin cessation rate in patients with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

et al. 2020

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Background Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.

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Section: Discussionmentioning

confidence: 99%

Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

et al. 2020

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“…Estudo na Turquia utilizou os resultados de lipidogramas para proceder à busca ativa de casos de HF, tendo verificado que muitos casos de elevação de LDL-c nem estavam recebendo tratamento. 9 De modo original, nesta investigação, verificamos que a prescrição de estatinas ocorre de modo disseminado na Instituição. Tal fato indica o conhecimento do fator de risco cardiovascular, mas sem necessariamente visar a uma meta específica, pois há grande variabilidade nos valores médios em cada especialidade, notadamente naquelas lidando com doenças cardiovasculares (Divisão de Cirurgia Vascular do Departamento de Cirurgia e Departamento de Neurologia).…”

Section: Discussionunclassified

Perfil de Prescrição de Estatinas e de Níveis Lipêmicos em Ambulatórios de Hospital Terciário Público

Schmidt

Moreira

Volpe

et al. 2021

Arquivos Brasileiros De Cardiologia

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Fundamento: O surgimento de nova classe de medicamentos com elevada capacidade de reduzir o LDL-colesterol (LDL-c) renovou o interesse na caracterização da hipercolesterolemia familiar (HF). Pouco se conhece do perfil lipídico de pacientes em atendimento terciário em nosso meio para caracterizar a real ocorrência de HF, que começa a ser suspeitada com níveis de LDL-c acima de 190mg/dL. Objetivos: O estudo avaliou o perfil lipídico (colesterol total [CT] e LDL-c) de pacientes de hospital público terciário. Métodos: Estudo retrospectivo de avaliação de prescrições de estatinas e resultados dos lipídios. O nível de significância foi estabelecido em 5%. Resultados: Em 1 ano, 9.594 indivíduos receberam prescrição ambulatorial de estatinas, 51,5% do gênero feminino, idade média de 63,7±12,9 anos (18 a 100 anos). Trinta e duas especialidades prescreveram estatinas, sendo a cardiologia responsável por 43%. Cerca de 15% das prescrições não tinham dosagem recente de CT, e 1.746 (18,0%) não apresentavam resultado recente de LDL-c. A ocorrência de LDL-c > 130mg/dL e < 190mg/dL ocorreu em 1.643 (17,1%) casos, e 228 (2,4%) apresentaram LDL-c ≥ 190mg/dL dentre os que utilizavam estatinas nas diversas doses. Apenas duas estatinas foram utilizadas: sinvastatina e atorvastatina, e a primeira foi prescrita em 77,6% das receitas. Conclusão: Nesta coorte transversal de hospital terciário, foi possível verificar que a prescrição de estatinas é disseminada, mas que a obtenção de metas adequadas de CT e LDL-c não é atingida em grande percentual, e que há, possivelmente, significativo contingente de portadores de HF que necessitariam ser investigados por suas implicações prognósticas.

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“…Many people with diabetes are not intended to use insulin due to the fear of hypoglycemia or weight gain or becoming dependent on insulin treatment ( 31 , 32 ). Negative media coverage is also a significant reason for the incompliance especially of statins ( 22 , 33 , 34 ). Polypharmacy is also a major obstacle in reducing patient compliance and the attainment of targets ( 35 ).…”

Section: Diabetic Kidney Disease (Dkd): Scope Of the Problemmentioning

confidence: 99%

Challenges in the Prevention and Management of Diabetic Kidney Diseases

Sönmez

2021

Front. Clin. Diabetes Healthc.

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If you define the problem correctly, you almost have the solution" Steve Jobs BACKGROUND Diabetic kidney disease (DKD) is one of the common complications of diabetes mellitus, which substantially decreases the quality of life and increases the risk of premature mortality (1). Although it is the most common cause of end-stage renal disease (ESRD) (2), the mortality is mostly due to cardiovascular diseases and therefore DKD is regarded as a major cardiovascular risk factor (3, 4). Due to its chronic and slowly progressing nature, DKD is generally diagnosed by screening tests showing albuminuria or low eGFR, or both in subjects with diabetes. Up to one-third of patients with type 1 diabetes (T1DM) (5-7)and nearly half of patients with type 2 diabetes (T2DM) have DKD (6,(8)(9)(10)). Yet, fewer of them receive optimal care to prevent DKD progression and avoid the cardiovascular and renal endpoints (11).Although the term "Diabetic Nephropathy" is used interchangeably with DKD, the former more specifically describes the histological alterations such as glomerular basement membrane thickening, or mesangial proliferation observed in subjects with T1DM, which predominantly occurs due to chronic hyperglycemia (12). However, DKD observed in subjects with T2DM involves Diabetic Nephropathy but also the alterations seen due to other causes such as aging, hypertension, or obesity. This is probably the reason for observing DKD more frequently in subjects with T2DM. As multiple risk factors play role in the pathogenesis of DKD and its cardiovascular consequences, intensive glucose control is not enough to prevent renal and cardiovascular endpoints in DKD (13). Therefore, chronic risk management is essential along with good glycemic regulation, to prevent the occurrence and progression of DKD and to reduce the premature cardiovascular events in patients with diabetes (14-17).Unfortunately, the global data shows that people with diabetes are not under good glycemic control, nor they attain the metabolic targets (18)(19)(20). We have recently performed a nationwide survey in Turkey (6). Our findings replicate the global data and show that less than half of patients with T2DM reach the target HBA1c levels and only 10% of them simultaneously attain the targets for blood glucose, blood pressure, LDL Cholesterol. The situation is even worse in patients with T1DM, with less than 5% attainment rates of the three targets. When we also consider smoking cessation and regular exercise, only 1.5% of patients with both types of diabetes reach all these targets simultaneously (6). There is also significant inertia in establishing appropriate targets and

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Identifying Undiagnosed or Undertreated Patients with Familial Hypercholesterolemia from the Laboratory Records of a Tertiary Medical Center

Cited by 4 publications

References 0 publications

Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

Perfil de Prescrição de Estatinas e de Níveis Lipêmicos em Ambulatórios de Hospital Terciário Público

Challenges in the Prevention and Management of Diabetic Kidney Diseases

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