Cultural Barriers in the Treatment of Dyslipidemia: A Survey of Japanese Physician Attitudes

Aims: To gain a more accurate understanding of the current real-world management of dyslipidemia in Japan, an online survey was conducted in a variety of physicians from five medical fields. Methods: A web-based survey with online questionnaire was designed, and members of an on-line information service for physicians were invited to participate. The survey enrolled 500 physicians, 100 in each of five categories: cardiology; diabetes, metabolism and endocrinology; neurology/neurosurgery/stroke medicine; general internal medicine (hospitals ≥ 20 beds), and general internal medicine (self-employed practitioners at clinics or small hospitals ≤ 19 beds). Results: Regardless of their specialties, most physicians recognized high low density lipoprotein cholesterol level as an important risk for atherosclerotic cardiovascular disease. Physicians with expertise in cardiology, diabetes, metabolism and endocrinology were most in favor of drug-based cholesterol lowering. Specialists in neurology/neurosurgery/stroke medicine and in general internal medicine were more concerned about statin safety and aggressive lipid-lowering therapy than those in cardiology and diabetes, metabolism and endocrinology, and tended to treat fewer patients with familial hypercholesterolemia (FH). Especially, those in general internal medicine (self-employed practitioners at clinics or small hospitals ≤ 19 beds) made less use of techniques for diagnosing FH. Conclusions: Awareness of target values for lipid management and of adverse reactions to drug therapy appears to vary somewhat depending on the participant's medical specialty. We also found that FH is probably underdiagnosed in Japan today. Further educations on proper diagnosis and management of dyslipidemia are required for physicians who are not specialized in cardiovascular health.