Key Points
• Source: Atherosclerosis Plus
• Conclusion: “FH is under-treated in Germany compared to guideline recommendations. Male gender, genetic proof of FH, treatment by a specialist, and presence of ASCVD appear to be associated with increased treatment intensity. Achieving the LDL-C goals of the 2019 ESC/EAS dyslipidemia guidelines remains challenging if pre-treatment LDL-C is very high.”
• The Cascade Screening and Registry for High Cholesterol (CaRe High) project was developed by researchers in 2015 to address the underdiagnosis and undertreatment of FH in Germany. The current interim analysis of the registry assesses the status of treatment and achievement of LDL-C goals per to the 2016 and 2019 ESC/EAS dyslipidemia guidelines among the first cohort of 1501 patients.
• This interim analysis supports that lipid-lowering treatment of FH patients in Germany falls short and needs improvement. Treatment intensity is corelated with sex, ASCVD, therapy-naïve LDL-C, and a positive genetic test result. These results should encourage physicians to consider genetic testing more often when FH is suspected to enhance awareness and treatment intensity to achieve treatment goals and decrease cardiovascular risk.
• Limitations of the current study include the non-mandatory inclusion of genetic testing in the registry. Regardless, the investigators increased the availability of results of such testing from 11% to 20%, with 51% of tested patients exhibiting an FH-causing mutation.
• “The genes that were analyzed were mostly selected by the treating physicians or may have been limited by the available methods; therefore, they may not have included all candidate genes, and the rate of genetically detectable FH may be higher than reported here. As 87% of patients in the CaRe High registry are treated by lipid specialists, data from the current study are not representative of the ambulatory sector in general,” the authors wrote.