Prevalence of heterozygous familial hypercholesterolaemia and its impact on long-term prognosis in patients with very early ST-segment elevation myocardial infarction in the era of statins

Rallidis, Lοukianos S.; Triantafyllis, Andreas S.; Tsirebolos, Georgios; Katsaras, Dimitrios; Rallidi, Maria; Moutsatsou, Paraskevi; Lekakis, J.

doi:10.1016/j.atherosclerosis.2016.03.023

Cited by 42 publications

(25 citation statements)

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“…This qualified all our cohort, with minimal exclusion criteria, for initiation of PCSK9 inhibitor therapy, a cohort much more diverse than those in the placebo-controlled randomized clinical trials [9, 11]. Rallidis et al have recently demonstrated that in patients who presented with myocardial infarction, 20% had definite/probable HeFH and 51% had possible HeFH [35]. Over a 9-year follow-up period, 39% of 255 patients had a major adverse coronary event despite 84.3% being on statins, with only 2.3% achieving LDLC <70 mg/dl [35].…”

Section: Discussionmentioning

confidence: 97%

“…Rallidis et al have recently demonstrated that in patients who presented with myocardial infarction, 20% had definite/probable HeFH and 51% had possible HeFH [35]. Over a 9-year follow-up period, 39% of 255 patients had a major adverse coronary event despite 84.3% being on statins, with only 2.3% achieving LDLC <70 mg/dl [35]. Definite/probable HeFH was independently associated with major adverse coronary events [35].…”

Section: Discussionmentioning

confidence: 99%

“…Over a 9-year follow-up period, 39% of 255 patients had a major adverse coronary event despite 84.3% being on statins, with only 2.3% achieving LDLC <70 mg/dl [35]. Definite/probable HeFH was independently associated with major adverse coronary events [35]. Our current study cohort included 25 patients with HeFH only, 25 with CVD only, and 22 with both.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study

et al. 2017

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BackgroundEfficacy and safety of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, alirocumab (ALI) and evolocumab (EVO) have previously been evaluated through controlled clinical trials with selective patient groups. Post-commercially, in patients with heterozygous familial hypercholesterolemia (HeFH) and/or cardiovascular disease (CVD) with suboptimal LDL cholesterol (LDLC) lowering on maximal tolerated cholesterol lowering therapy, we assessed efficacy and safety of ALI and EVO.MethodsPost-commercially, we started 25 patients on ALI 75 mg, 15 on ALI 150 mg, and 32 on EVO 140 mg bi-weekly added to entry LDLC lowering regimen, with follow-up for a median 24 weeks. History, physical exam, demographics, and adverse event data were collected. Changes in LDLC and AHA and NIH calculated 10-year CVD risks were assessed on ALI and EVO.ResultsOf 72 patients, 25 had HeFH only, 25 CVD only, 22 had both, median age was 65 years, 63% females, 38% males, 86% Caucasian, 11% African-Americans, 17% diabetics, 63% on anti-hypertensives, and 7% smokers. At entry, 30 (42%) were on a statin and 42 (58%) could not tolerate any statins.At 24-weeks, median LDLC decreased on ALI 75 mg from 117 to 62 mg/dL (−54%), on ALI 150 mg from 175 to 57 mg/dL (−63%), and on EVO 140 mg from 165 to 69 mg/dL (−63%), p <0.0001 for all. Absolute and percent LDLC reduction did not differ (p >.05) between ALI 150 and EVO 140 mg, but were less on ALI 75 mg vs ALI 150 mg and EVO 140 mg (p <.05).Percent reductions in 10-year CVD risks by AHA and NIH calculators, respectively were ALI 75 mg −22 and −44%, ALI 150 mg −31 and −50%, and EVO 140 mg −29 and −56%, p ≤.002 for all.The three most common adverse events included flu-like myositis 10%, respiratory tract symptoms 8%, and injection site reaction 6%.ConclusionIn patients with HeFH and/or CVD, LDLC was lowered by 63% on EVO and ALI 150 mg, and 54% on ALI 75 mg. Adverse events were minimal and tolerable. ALI and EVO represent paradigm shifts in LDLC lowering. Long term, post-commercial safety and efficacy remain to be determined.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study

et al. 2017

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“…Recently, Rallidis et al reported that one of five patients who develop very early ST-segment elevation myocardial infarction at ≤ 35 years of age has definite/probable heterozygous FH and, despite the use of statins, there is a therapeutic gap and a high recurrence rate of cardiac events during long-term follow-up [7]. Although the LDL-C level for secondary prevention and FH patients is less than 100 mg/dL according to the JAS Guidelines of 2012, patients with FH must be treated under the guidance of a specialist.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in a 26-Year-Old Patient With Familial Hypercholesteremia

et al. 2016

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A 26-year-old male suffered sustained chest pain. Electrocardiogram showed ST-segment elevation in the anteroseptal wall and reciprocal ST-segment change in the inferior wall. The troponin-I level and the white blood cell count were elevated. We gave a diagnosis of acute myocardial infarction. He underwent urgent coronary angiography, which revealed 90% diffuse stenosis in the middle right coronary artery and total occlusion in the proximal left anterior descending coronary artery (LAD). Since the electrocardiogram indicated that the culprit lesion was in the proximal LAD, we performed percutaneous coronary intervention. The coronary flow in the LAD was classified as thrombolysis in myocardial infarction trial 3. His coronary risk factors were obesity, smoking, family history, hypertension and diabetes, in addition to heterozygous familial hypercholesteremia (FH). Herein, we describe the case of a young patient with acute anteroseptal myocardial infarction and discuss the potential importance of controlling cholesterol levels in FH.

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“…There is a therapeutic gap and a high recurrence rate of cardiac events during long-term follow-up. 6) Although the LDL-C level for patients with secondary prevention and/or FH is less than 100 mg/dL according to the 2012 JAS Guidelines, patients with FH must be treated using combinations of lipidlowering drugs under the care of specialists. In this respect, an additional therapeutic option is now available, which entails the use of proprotein convertase subtilisin/Kexin 9 (PCSK9) inhibitors.…”

Section: Article P88mentioning

confidence: 99%

Acute Coronary Syndrome With or Without Heterozygous Familial Hypercholesterolemia

Miura

2017

Int. Heart J.

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Prevalence of heterozygous familial hypercholesterolaemia and its impact on long-term prognosis in patients with very early ST-segment elevation myocardial infarction in the era of statins

Cited by 42 publications

References 30 publications

Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study

Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study

Acute Myocardial Infarction in a 26-Year-Old Patient With Familial Hypercholesteremia

Acute Coronary Syndrome With or Without Heterozygous Familial Hypercholesterolemia

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