Background Atherosclerotic cardiovascular disease (ASCVD) is the primary cause of death in Saudi Arabia. Hypercholesterolemia is a prevalent risk factor that can lead to ASCVD. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines have provided recommendations for managing severe primary hypercholesterolemia, defined as medically well adults 21-75 years of age with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL (≥4.9 mmol/L). Underutilization of the guideline recommendations has led to concern and the need for further review. This study aims to review the management of severe primary hypercholesterolemia in the Family Medicine and Polyclinics at King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, Saudi Arabia. Methodology In this retrospective cohort study, data were obtained from electronic medical records of patients aged 21-75 years who received care in the Family Medicine and Polyclinics at KFSH&RC in Riyadh with LDL-C ≥190 (≥4.9 mmol/L). The data collected included demographics, body mass index (BMI), LDL-C blood level, and lipid-lowering medications prescribed. We measured the prevalence of hypercholesterolemia, reviewed if appropriate statin therapy was prescribed as per the ACC/AHA guidelines, and determined if treated patients with severe primary hypercholesterolemia achieved LDL-C ≤100 mg/dL (≤2.6 mmol/L) from January 1, 2015, until June 30, 2020. Results The prevalence of hypercholesterolemia was 7.4%. The sample size studied included 195 patients. The majority of patients were aged 40-59 years and were either overweight or obese. Treatment with a moderate-intensity statin was observed in 46.4% of patients, and 45.4% of patients were not prescribed a statin. The LDL-C ≤100 mg/dL (≤2.6 mmol/L) was not achieved in 88.3% of patients. Conclusions Despite guidelines, the majority of patients with severe primary hypercholesterolemia are inadequately managed. High-risk patients need to be diagnosed appropriately so that they receive proper treatment to prevent ASCVD. We encourage adherence to established guidelines in the management of severe primary hypercholesterolemia to prevent premature ASCVD.
Keywords: atherosclerotic cardiovascular disease; family medicine; hypercholesterolemia; ldl-c; lipid lowering.
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