Dataset Information

Prevalence, treatment, and control of severe hyperlipidemia.

ABSTRACT:

Objective

To identify the prevalence, treatment, and low-density lipoprotein cholesterol (LDL-C) control of individuals with LDL-C ≥190 mg/dL in contemporary clinical practice.

Methods

We included adults (age ≥18 years) with LDL-C ≥190 mg/dL, at least one LDL-C level drawn from 255 health systems participating in Cerner HealthFacts database (2000-2017, n = 4,623,851), and a detailed examination within Duke University Health System (DUHS, 2015-2017, n = 267,710). Factors associated with LDL-C control were evaluated using multivariable logistic regression modeling.

Results

The cross-sectional prevalence of LDL-C ≥190 mg/dL was 3.0% in Cerner (n = 139,539/4,623,851) and 2.9% at DUHS (n = 7728/267,710); among these, rates of repeat LDL-C measurement within 13 months were low: 27.9% (n = 38,960) in Cerner, 54.5% (n = 4211) at DUHS. Of patients with follow-up LDL-C levels, 23.6% in Cerner had a 50% of greater reduction in LDL-C, 18.3% achieved an LDL-C <100 mg/dL and 2.7% < 70 mg/dL. At DUHS, 28.4% had a 50% or greater reduction in LDL-C, 28.4% achieved an LDL-C ≤100 mg/dL and 4.4% achieved <70 mg/dL. Within DUHS, 71.6% with LDL-C ≥190 mg/dL were on any statin during follow-up, but only 28.5% were on a high-intensity statin. In multivariable modeling, seeing a cardiologist (Cerner odds ratio [OR] 1.56, confidence interval [CI] 1.33-1.83; DUHS OR 1.89, 95% CI 1.18-3.01) and having diabetes (Cerner OR 1.34 CI 1.23-1.46; DUHS OR 2.07, CI 1.62-2.65) increased odds of LDL-C control, defined as a ≥50% reduction in LDL-C (at Cerner) or initiation of high intensity statin (at DUHS). Prior atherosclerotic cardiovascular disease (OR 1.19, CI 1.07-1.33), hypertension (OR 1.10, CI 1.03-1.18), African American race (OR 0.79, CI 0.71-0.89), and government (vs. private) insurance (OR 0.90, CI 0.83-0.98) were associated with LDL-C control at Cerner. Female sex was associated with lower odds of appropriate therapy (OR 0.69, CI 0.59-0.81) at DUHS.

Conclusions

Approximately 3% of United States adults have LDL-C ≥190 mg/dL. Among those with very high LDL-C, rates of repeat measurement within one year were low; of those retested, only about one-fourth met guideline-recommended LDL-C treatment goals.

SUBMITTER: Gold ME

PROVIDER: S-EPMC8315339 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Hypothyroidism can cause a variety of manifestations, including cardiovascular disorders. The most frequent clinical signs are sinus bradycardia and pericardial effusion. The affected patient generally has significant symptoms. Hypothyroidism infrequently results in a complete atrioventricular block. Case presentation A 19-year-old girl presented to our cardiology clinic with generalized tiredness, edema in her lower limbs and face, constipation, and a menstruation abnormality in the previous six months. With a normal ejection fraction on echocardiography, an electrocardiogram revealed complete atrioventricular block. When she was admitted, her laboratory testing showed that she had severely raised Thyroid Stimulating Hormone (TSH) levels, severe dyslipidemia with normal electrolytes, and normal liver and kidney function tests. The patient was treated with 50mg Thyroxine to her. She had significant improvement within two weeks of treatment. Up on the next follow-up (at one-month), her electrocardiogram returned to normal sinus rhythm without any evidence of atrioventricular block and that the lipid profile had returned to normal. Clinical discussion In its first stages, hypothyroidism can not show any obvious symptoms. Untreated hypothyroidism over time can lead to a variety of health issues, including obesity, joint discomfort, infertility, and heart disease. This current case demonstrates how levothyroxine medication successfully managed a young female patient's severe hypothyroidism, difficult total heart block, severe hyperlipidemia, and long-standing menstrual irregularity. Conclusion We found that overt hypothyroidism caused a complete atrioventricular block and severe dyslipidemia, and that thyroxin therapy completely corrected both conditions. Highlights • We have seen a literature review the importance of finding out possible underlying cause of.complete heart block before intervention.• Thyroid dysfunction can cause severe complication like complete heart block,dyslipidaemia and menstrual dysregulation.• According to reports, levothyroxine alone can correct both av block and dyslipidaemia in the setting of hypothyroidism.• Here we present a case of severe hypothyroidism complicating complete heart block and hyperlipidemia which was successfully treated with Levothyroxine.