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High Cholesterol Is Significantly Undertreated

December 07, 2018

Less than 40% of individuals with familial hypercholesterolemia (FH) receive appropriate high-intensity statin therapy, according to new research.

For their study, the researchers assessed data from the 1999-2014 National Health and Nutrition Examination Survey on 42,471 US adults (weighted to represent 212 million US adults) with FH and with severe dyslipidemia.

Sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy were examined using logistic regression.

Results indicated that the estimated prevalence of definite or probable FH and of severe dyslipidemia in the United States was 0.47% and 6.6%, respectively. A high frequency (more than 80%) of cholesterol screening and awareness was observed among this cohort. However, only about 30.3% of patients with definite or probable FH who were treated with statins were receiving a high-intensity statin.

The researchers noted that, although the prevalence of statin use among adults with severe dyslipidemia had increased over time—from 29.4%. to 47.7%—it occurred no faster than trends observed in the general population (5.7% to 17.6%).

Factors that predicted higher statin use included older age, health insurance status, having a usual source of care, diabetes, hypertension, and personal history of early atherosclerotic cardiovascular disease.

“Despite the high prevalence of cholesterol screening and awareness, only [approximately 50%] of adults with FH are on statin therapy, with even fewer prescribed a high-intensity statin; young and uninsured patients are at the highest risk for lack of screening and for undertreatment,” the researchers wrote.

“This study highlights an imperative to improve the frequency of cholesterol screening and statin prescription rates to better identify and treat this high-risk population,” they added. “Additional studies are needed to better understand how to close these gaps in screening and treatment.”

—Christina Vogt


Bucholz EM, Rodday AM, Kolor K, Khoury MJ, de Ferranti SD. Prevalence and predictors of cholesterol screening, awareness, and statin treatment among US adults with familial hypercholesterolemia or other forms of severe dyslipidemia (1999-2014). Circulation. 2018;137(12).

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