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Inicio Clínica e Investigación en Arteriosclerosis (English Edition) Clinical profile of severe hypercholesterolemia in 156,000 adults in primary car...
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Vol. 36. Issue 1.
Pages 1-11 (January - February 2024)
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Vol. 36. Issue 1.
Pages 1-11 (January - February 2024)
Original article
Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care
Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria
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Teresa Gijón-Condea,b,c,
Corresponding author
tgijon@salud.madrid.org

Corresponding author.
, Carolina Ferré Sáncheza, Isabel Ibáñez Delgadoa, Berenice Rodríguez Jiméneza, José R. Banegasd
a Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, Spain
b Unidad Docente de Medicina de Familia, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
c Asociación MAdrileña de Riesgo Enfermedad VAscular (AMAREVA), Madrid, Spain
d Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Tables (3)
Table 1. General characteristics of subjects with severe hypercholesterolemia, according to gender.
Table 2. Distribution of subjects with severe hypercholesterolaemia (subjects with LDL-C values available for having triglycerides < 400 mg/dl) and according to LDL-C categories in the last analysis available; decades of age, and lipid-lowering drug treatment.
Table 3. Lipid-lowering drug treatment by intensity and presence of cardiovascular disease.
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Abstract
Objective

To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of ​​the Community of Madrid (CAM).

Material and methods

Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥ 300 mg/dL or LDL-cholesterol ≥ 220 mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥ 240 mg/dL (≥160 mg/dL if lipid-lowering treatment) with triglycerides < 200 mg/dL and TSH < 5 uIU/ml.

Results

156,082 adults ≥ 18 years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI 3.87%–4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8 years; 36.5% had hypertension; 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65,7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100 mg/dl of 1.8%, 5.8% and 20.2%, respectively. (vs 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (1.03%, 0.98%–1.08%).

Conclusions

Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

Keywords:
Dyslipidaemia
Cardiovascular risk
Cardiovascular disease
Familial hypercholesterolemia prevalence
Resumen
Objetivo

Estimar la frecuencia y perfil clínico de la hipercolesterolemia severa (HS) y del fenotipo de hipercolesterolemia familiar (HF) en el ámbito de atención primaria, en un área sanitaria de la comunidad de Madrid (CAM).

Material y métodos

Estudio transversal, multicéntrico de sujetos con tarjeta sanitaria adscritos a 69 centros de salud (área NorOeste/CAM). Se definió HS como colesterol ≥ 300 mg/dL o colesterol-LDL ≥ 220 mg/dL en alguna analítica realizada (1-1-2018 a 30-12-2021); y fenotipo de HF como c-LDL ≥ 240 mg/dL (≥160 mg/dL si tratamiento hipolipemiante), con triglicéridos < 200 mg/dL y TSH < 5 uIU/ml.

Resultados

Se analizaron 156.082 adultos ≥ 18 años con perfil lipídico disponible. 6.187 sujetos tenían HS (3,96% de las analíticas estudiadas, IC95% 3,87%–4,06%). El tiempo medio de evolución del diagnóstico de hiperlipemia en la historia clínica informatizada fue 10,8 años; 36,5% tenían hipertensión; 9,5% diabetes y 62,9% sobrepeso/obesidad. El 83,7% tomaban hipolipemiantes (65,7% de baja/moderada y 28,6% de alta/muy-alta intensidad). El 6,1% tenían enfermedad cardiovascular (94,2% tratados con hipolipemiantes), con colesterol-LDL <55, <70 y <100 mg/dl de 1,8%, 5,8% y 20,2%, respectivamente (vs 1%, 2.3% y 11.2% si no había enfermedad cardiovascular). 1600 sujetos tenían fenotipo de HF (1,03%, 0,98%–1,08%).

Conclusiones

Cuatro de cada 100 pacientes analizados en atención primaria tienen HS. Hay un elevado nivel de tratamiento farmacológico, pero de insuficiente intensidad, y escaso logro de objetivos terapéuticos. Uno de cada 100 tiene fenotipo de HF. La identificación de ambas situaciones por registros informatizados permitiría su detección más precisa y precoz y establecer estrategias preventivas cardiovasculares.

Palabras clave:
Dislipidemia
Riesgo cardiovascular
Enfermedad cardiovascular
Prevalencia hipercolesterolemia familiar

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