Thirty percent of children and young adults with familial hypercholesterolemia treated with statins have adherence issues

Am J Prev Cardiol. 2021 Apr 2;6:100180. doi: 10.1016/j.ajpc.2021.100180. eCollection 2021 Jun.


Objective: To assess adherence to lipid lowering therapy (LLT), reasons for poor adherence, and achievement of LDL-C treatment goals in children and young adults with familial hypercholesterolemia (FH).

Methods: Retrospective review of the medical records of 438 children that started follow-up at the Lipid Clinic, Oslo University hospital, between 1990 and 2010, and followed-up to the end of July 2019. Based on information on adherence to the LLT at the latest visit, patients were assigned to "good adherence" or "poor adherence" groups. Reasons for poor adherence were categorized as: "lack of motivation", "ran out of drugs", or "side effects".

Results: Three hundred and seventy-one patients were included. Mean (SD) age and follow-up time at the latest visit was 24.0 (7.1) and 12.9 (6.7) years; 260 patients (70%, 95% CI: 65-74%) had "good adherence" and 111 (30%, 95% CI: 25-35%) had "poor adherence". "Lack of motivation" was the most common reason for poor adherence (n = 85, 23%). In patients with good adherence, compared to patients with poor adherence, age at latest visit (24.6 versus 22.0 years; p = 0.001), years of follow-up (13.5 versus 11.4 years; p = 0.003), and number of visits (8.1 versus 6.5 visits; p<0.001) were significantly higher, whereas LDL-C at the latest visit was lower, (3.1 (0.8) versus 5.3 (1.6) mmol/L; p<0.001) and percentage of patients reaching LDL-C treatment goal was higher, (34.5% versus 2.7%; p<0.001). Gender, BMI, age at first visit and premature cardiovascular disease in first degree relatives were not significantly associated with adherence.

Conclusion: Thirty percent of young patients with FH had poor adherence to LLT, with lack of motivation as the main reason. Higher age, more visits and more years of follow-up were associated with good adherence.

Keywords: Adherence; Children; Familial hypercholesterolemia; Statins; Young adults.