Predicting non-adherence in patients with familial hypercholesterolemia

Galema-Boers, J.M.H.; Lenzen, Mattie J.; Domburg, Ron T. van; Lennep, Jeanine Roeters van; Scheur, G. G. van Bruchem-van de; Sijbrands, Eric J.G.; Langendonk, Janneke G.

doi:10.1007/s00228-013-1640-3

Cited by 28 publications

(19 citation statements)

References 35 publications

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“…The suboptimal outcome of statin therapy can be attributed, at least in part, to nonadherence: although patients with FH have a considerable increase in CVD risk, nonadherence to statin treatment is common in these patients (as for other patients at highrisk of CVD) and can seriously compromise achievement of the LDL-C target level and efficient prevention of CVD. 45 As for all patients, nonadherence results from misperceptions from the public and the patients, and insufficient knowledge and awareness of CVD risk factors such as hypercholesterolaemia. Nonadherence can also result from inappropriate knowledge by physicians, inappropriate statin choice, or failure to titrate statin dosage adequately.…”

Section: Efficacymentioning

confidence: 99%

Management of patients with familial hypercholesterolaemia

Reiner

2015

Nat Rev Cardiol

101

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Familial hypercholesterolaemia (FH) is an autosomal inherited disorder characterized by markedly elevated LDL-cholesterol (LDL-C) levels and an increased risk of premature atherosclerotic cardiovascular disease. Although FH is one of the most common genetic disorders, this disorder remains mostly undetected and its management is often suboptimal. High-intensity statins are standard treatment for patients with FH, but LDL-C levels in most patients treated with statin monotherapy remain above those recommended by guidelines. Combination therapy to lower LDL-C levels further-such as treatment with statins plus ezetimibe-has been successful, and combination of apheresis with high-intensity statin treatment is used in patients with homozygous FH and in those with heterozygous FH who are statin-refractory. Mipomersen, an inhibitor of apolipoprotein B-100 synthesis, and lomitapide, a microsomal triglyceride transfer protein inhibitor, reduce LDL-C levels further when added to high-intensity statin treatment in homozygous FH, but both have important adverse effects, such as increasing liver fat content. At present, PCSK9 inhibition (with alirocumab or evolocumab) is well tolerated and reduces LDL-C levels considerably in patients receiving the maximally tolerated statin treatment, and seems the most promising emerging treatment option. Nevertheless, data from outcome trials with hard end points for PCSK9 inhibitors, mipomersen, and lomitapide are still needed before these therapies become standard for patients with FH.

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Section: Efficacymentioning

confidence: 99%

Management of patients with familial hypercholesterolaemia

Reiner

2015

Nat Rev Cardiol

101

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“…Только у 22 % пациентов с СГХС был достигнут уровень ХС ЛНП менее 2,5 ммоль / л и в другом исследовании [7]. Сходные результаты получили J. M. Galema-Boers и соавт., только у 19 % были достигнуты целевые уровни ХС ЛНП [12]. Безусловно, некоторые различия в данных исследованиях могут быть обусловлены тем, что целевые уровни для пациентов из группы высокого и очень высокого риска пересматривались.…”

Section: Discussionunclassified

“…Было показано, что пациенты моложе 36 лет были в 10 раз менее привержены к терапии, чем лица старше 51 года. Пациенты с исходным уровнем ОХС менее 8 ммоль / л были в 4 раза менее привержены к терапии, чем те, у кого уровень ОХС был более 10 ммоль / л [12]. На принятие решения о необходимости терапии влияют возраст, уровень ХС ЛНП и ХС липопротеинов высокой плотности [7].…”

Section: Discussionunclassified

Lipid Lowering Therapy with Statins in Patients with Heterozygous Familial Hypercholesterolemia

2019

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Aim: to analyze adherence of FH patients with familial hypercholesterolemia (FH) to the statin therapy and reveal factors, which influence it; to assess the degree of target level of low-density lipoprotein cholesterol (LDLCH) achievement by FH patients on statin therapy. Materials and methods. We included in this study 203 FH patients aged >18 years (mean age 50.0±1.1 years, 82 men). Definite FH was diagnosed in 96 persons, in the other patients FH was considered possible. For evaluating the adherence to therapy with statins we used the Morisky-Green questionnaire. Results. Among patients with definite FH 57 % were adherent to lipid-lowering therapy, 16 % were partially adherent, and 27 % – not adherent. Target LDLCH levels were achieved in 22.6 % and 12.5 % of patients with definite and possible FH, respectively. Smoking and gender were not associated with adherence to statin therapy. Factors associated with higher adherence were age (p=0.000003), arterial hypertension (odds ratio [OR] 1.90, 95 % confidence interval [CI] 1.02 to 3.55], p=0.044), ischemic heart disease (IHD) (OR=2.99, 95 %CI 1.50 to 5.97, p=0.002), history of myocardial infarction (MI) (OR 5.26, 95 %CI 2.03 to 13.60, p=0.0006), history of myocardial revascularization (OR 20.3, 95 %CI 2.64 to 156.11, p=0.004) and the fact of achieving target LDLCH level (OR 19.93, 95 %CI 7.03 to 56.50, p<0.0001). The main reason for the refuse from statin therapy in 87 % of patients was fear of side effects. Main reasons for stopping of ongoing therapy were: myalgia, an increase in transaminases, skin rashes, and high cost in 12, 35, 12, and 6 % of patients, respectively. The decision to withdraw therapy with statins was made by 29 % of patients by themselves. Conclusion. In this study 57 % of patients with definite FH were adherent to statin therapy. Factors associated with increased adherence were age, hypertension, IHD, history of MI, history of myocardial revascularization, achievement of target LDLCH level. Target LDLCH levels were achieved by 22.6 and 12.5 %% of patients with definite and possible FH, respectively.

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“…Considering that approximately half of the patients requiring treatment due to chronic disease do not adhere to the therapeutic plan, the assessment of patient adherence to treatment plays a pivotal role in the description and verification of the therapeutic process [43][44][73][74][75]. Thus, the search for available tools for adherence assessment as well as evaluation of their characteristics is necessary [76][77][78].…”

Section: Expert Opinionmentioning

confidence: 99%