Cardiology clinic visit increases likelihood of evidence-based cholesterol prescribing in severe hypercholesterolemia

Nicole A. Groth, Neil J. Stone, Catherine P. Benziger*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Patients with phenotypic severe hypercholesterolemia (SH), low-density lipoprotein-cholesterol (LDL-c) ≥ 190 mg/dl, atherosclerotic cardiovascular disease (ASCVD) or adults 40–75 years with diabetes with risk factors or 10-year ASCVD risk ≥20% benefit from maximally tolerated statin therapy. Rural patients have decreased access to specialty care, potentially limiting appropriate treatment. Hypothesis: Prior visit with cardiology will improve treatment of severe hypercholesterolemia. Methods: We used an electronic medical record-based SH registry defined as ever having an LDL-c ≥ 190 mg/dl since January 1, 2000 (n = 18 072). We excluded 3205 (17.7%) patients not alive or age 20–75 years. Patients defined as not seen by cardiology if they had no visit within the past 3 years (2017–2019). Results: We included 14 867 patients (82.3%; mean age 59.7 ± 10.3 years; 58.7% female). Most patients were not seen by cardiology (n = 13 072; 72.3%). After adjusting for age, sex, CVD, hypertension, diabetes and obesity, patients seen by cardiology were more likely to have any lipid-lowering medication (OR = 1.46, 95% CI: 1.29–1.65), high-intensity statin (OR = 1.81, 95% CI: 1.61–2.03), or proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor (OR = 5.96, 95% CI: 3.34–10.65) compared to those not seen by cardiology. Mean recent LDL-c was lower in patients seen by cardiology (126.8 ± 51.6 mg/dl vs. 152.4 ± 50.2 mg/dl, respectively; p <.001). Conclusion: In our predominantly rural population, a visit with cardiology improved the likelihood to be prescribed any statin, a high-intensity statin, or PCSK9 inhibitor. This more appropriately addressed their high life-time risk of ASCVD. Access to specialty care could improve SH patient's outcomes.

Original languageEnglish (US)
Pages (from-to)186-192
Number of pages7
JournalClinical Cardiology
Issue number2
StatePublished - Feb 2021


  • atherosclerotic cardiovascular disease
  • guideline adherence
  • low-density lipoprotein cholesterol
  • rural healthcare
  • severe hypercholesterolemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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