Evaluating severe hypercholesterolemia in an uninsured, vulnerable population receiving care at a community clinic

Abstract

BackgroundIndividuals with LDL-C ≥190 mg/dL (severe hypercholesterolemia) require treatment with high-intensity statins and should be evaluated for underlying causes including Familial Hypercholesterolemia (FH). The characteristics of patients with LDL-C ≥ 190 mg/dL has been reported in routine healthcare settings, but limited data exist about uninsured populations.ObjectivesTo examine the scope of LDL-C ≥ 190 mg/dL in a clinic serving uninsured populations.MethodsPatients with LDL-C ≥190 mg/dL at North Dallas Shared Ministries, a charity, community clinic in Dallas, TX, were identified via query of the electronic health record, and data was extracted from medical charts. Patients were interviewed to obtain family history and assess knowledge of cholesterol levels.ResultsAmong 662 patients with lipid measurements, 27 had LDL-C ≥ 190 mg/dL (67% female, 78% Hispanic, mean age 52 years). Median pretreatment LDL-C was 210.5 mg/dL. Almost all (93%) were prescribed a statin, but only 33% were prescribed high-intensity statin. Treated LDL-C was 141 mg/dL. No patients had an ICD-10 diagnosis of FH, and only 31% had laboratory tests for secondary causes of hypercholesterolemia. Only 15% had any documentation of family history of hypercholesterolemia and/or ASCVD. After interviewing, we discovered previously undocumented family history of hypercholesterolemia in 54% and ASCVD in 31%.ConclusionsAmong the uninsured with LDL-C ≥ 190 mg/dL in a community clinic, the use of high-intensity statins was suboptimal, and most were not evaluated for causes of severe hypercholesterolemia. Future efforts to address gaps and education are warranted to improve care for severe hypercholesterolemia patients in this vulnerable population.Condensed AbstractFew studies evaluate severe hypercholesterolemia in uninsured populations. We queried the electronic health record at a charity community clinic to characterize individuals with severe hypercholesterolemia. Our results suggest more education is needed for patients and providers regarding severe hypercholesterolemia and FH to better care for this vulnerable population.