Problems that Physicians should Notice for Bet ter Treatment of Hypercholesterolemia in Japan

Abstract

At first, essentially, most physicians (over 95%) recognized high LDL-C level as an important risk for ASCVD. The mean target level for physicians with expertise in cardiology was the lowest of all the areas of clinical expertise (92.6±17.3 mg/dL), and in patients with a history or complications of diabetes, chronic kidney disease, noncardiogenic cerebral infarction, or peripheral arterial disease, the overall target level was 112.7±17.4 mg/dL. As for the statin therapy, participants were most concerned about muscle disorders as adverse effect, followed by new onset diabetes. In addition, physicians with expertise in neurology/neurosurgery/stroke were about twice as likely as other participants to agree with the statement “Japanese with low LDL-C are more likely to develop cerebral hemorrhage”, while over 70% of participants expressed concern about safety at LDL-C below 70 mg/dL. The authors stated that cardiology specialists tend to practice lipid-lowering treatment more aggressively than those with other areas of medical expertise, which may be because they generally treat secondary prevention patients and that the increasing number of patients who are candidates for secondary prevention of ASCVD could predispose these specialists to develop a mindset toward ASCVD therapy similar to that seen in the US and Europe. In addition, they suggested that less aggressive LDL-C target setting by the physicians with expertise in neurology/neurosurgery/ stroke might be partially related to their sense that the Japanese patients are generally at low risk for CV events even without achieving the currently recommended lipid levels. These results and comments may faithfully reflect current opinion of Japanese physicians and suggest several issues to overcome against the low rate of treatment for hypercholesterolemia. Next, 65.4% of participants had treated patients with FH, but the percentage was lower in physicians See article vol. 26: 154-169