Analysis of adherence to statin therapy among children with familial hypercholesterolemia: results of a 3-year prospective study


D.I. Sadykova (1), L.F. Galimova (1, 2), E.S. Slastnikova (1, 2), N.E. Usova (2), Ch.D. Khaliullina (1)

1) Kazan State Medical University, Kazan, Russia; 2) Children’s Republican Clinical Hospital, Kazan, Russia
Background. Familial hypercholesterolemia (FH) is a frequent genetic disease associated with the premature development of atherosclerosis. Patients with FH who do not receive treatment are at high risk of atherosclerotic diseases after 20 years. According to international and Russian recommendations, statin treatment should be considered in children with heterozygous form of the disease from the age of 8-10 years.
Objective. Evaluation of the adherence to statin therapy among children with FH and analysis of contributing factors.
Methods. For the period 2017-2020, 56 children with heterozygous FH were included in the study. The mean age of children was 13.92±3.1 years, the mean total cholesterol level – 7.8±2.1 mmol/L, low-density lipoproteins (LDL) – 6.0±1.1 mmol/L. All patients were prescribed atorvastatin at a starting dose of 10 mg. At follow-up visit after 1 month, only 4 (7%) children started statin therapy.
Results. The children of this group achieved LDL targets <3.5 mmol/l. At the next follow-up visit, after 3 months, another child began taking atorvastatin. By the end of the reported follow-up period (12 months), the proportion of patients taking statins had not increased, and amounted to 5 (9%) children. Against the background of treatment, none of the children had complaints and side effects. Based on the questionnaire, an analysis of the reasons for patients’ refusal of treatment was carried out. Reasons for lack of adherence to treatment were divided into three categories: patient-related, physician-related, and health system-related.
Conclusion. Modern lipid-lowering therapy has tremendous potential to improve prognosis in patients with FH. However, there is low adherence to statin treatment in pediatric practice. The main ways to solve the problem include psychological counselling, creation of a trust union between the doctor and the patient, as well as increasing the awareness of both patients and medical professionals.
Keywords: familial hypercholesterolemia, statins, atorvastatin, adherence to treatment

About the Autors

Corresponding author: Dinara I. Sadykova, Dr. Sci. (Med.), Head of the Department of Hospital Pediatrics, Kazan State Medical University, Kazan, Russia;
Address: 49 Butlerov St., Kazan 420012, Russian Federation

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