Abstract
ObjectiveTo identify the prevalence, treatment, and low-density lipoprotein cholesterol (LDL-C) control of individuals with LDL-C ≥190 mg/dL in contemporary clinical practice. MethodsWe included adults (age ≥18 years) with LDL-C ≥190 mg/dL, at least one LDL-C level drawn from 255 health systems participating in Cerner HealthFacts database (2000–2017, n = 4,623,851), and a detailed examination within Duke University Health System (DUHS, 2015–2017, n = 267,710). Factors associated with LDL-C control were evaluated using multivariable logistic regression modeling. ResultsThe cross-sectional prevalence of LDL-C ≥190 mg/dL was 3.0% in Cerner (n = 139,539/4,623,851) and 2.9% at DUHS (n = 7728/267,710); among these, rates of repeat LDL-C measurement within 13 months were low: 27.9% (n = 38,960) in Cerner, 54.5% (n = 4211) at DUHS. Of patients with follow-up LDL-C levels, 23.6% in Cerner had a 50% of greater reduction in LDL-C, 18.3% achieved an LDL-C <100 mg/dL and 2.7% < 70 mg/dL. At DUHS, 28.4% had a 50% or greater reduction in LDL-C, 28.4% achieved an LDL-C ≤100 mg/dL and 4.4% achieved <70 mg/dL. Within DUHS, 71.6% with LDL-C ≥190 mg/dL were on any statin during follow-up, but only 28.5% were on a high-intensity statin. In multivariable modeling, seeing a cardiologist (Cerner odds ratio [OR] 1.56, confidence interval [CI] 1.33–1.83; DUHS OR 1.89, 95% CI 1.18–3.01) and having diabetes (Cerner OR 1.34 CI 1.23–1.46; DUHS OR 2.07, CI 1.62–2.65) increased odds of LDL-C control, defined as a ≥50% reduction in LDL-C (at Cerner) or initiation of high intensity statin (at DUHS). Prior atherosclerotic cardiovascular disease (OR 1.19, CI 1.07–1.33), hypertension (OR 1.10, CI 1.03–1.18), African American race (OR 0.79, CI 0.71–0.89), and government (vs. private) insurance (OR 0.90, CI 0.83–0.98) were associated with LDL-C control at Cerner. Female sex was associated with lower odds of appropriate therapy (OR 0.69, CI 0.59–0.81) at DUHS. ConclusionsApproximately 3% of United States adults have LDL-C ≥190 mg/dL. Among those with very high LDL-C, rates of repeat measurement within one year were low; of those retested, only about one-fourth met guideline-recommended LDL-C treatment goals.
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