Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study

Iyen, Barbara; Qureshi, Nadeem; Kai, Joe; Akyea, Ralph Kwame; Leonardi‐Bee, Jo; Roderick, Paul; Humphries, Steve E.; Weng, Stephen

doi:10.1016/j.atherosclerosis.2019.05.017

Cited by 25 publications

(24 citation statements)

References 34 publications

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“…The global older mean age of the population in our study could explain the lower effect of FH-P on ASCVD compared to previous reports in genetically identified individuals who were younger than those included in our analysis; whereas the effect in the younger subgroup was similar. Our results in primary prevention are in agreement with previous reports, in a Norwegian population with FH [18] and recently in the Simon Broome Register [19] and in primary care subjects in UK [20]. There is no previous data on the excess of ASCVD incidence in persons with FH-P in secondary prevention.…”

Section: Discussionsupporting

confidence: 93%

Incidence of Cardiovascular Disease in Patients with Familial Hypercholesterolemia Phenotype: Analysis of 5 Years Follow-Up of Real-World Data from More than 1.5 Million Patients

Zamora

Plana

Comas-Cufí

et al. 2019

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In the statin era, the incidence of atherosclerotic cardiovascular diseases (ASCVD) in patients with familial hypercholesterolemia (FH) has not been updated. We aimed to determine the incidence of ASCVD in patients with FH-phenotype (FH-P) and to compare it with that of normal low-density lipoprotein cholesterol (LDL-C) patients. We performed a retrospective cohort study using the Database of the Catalan primary care system, including ≥18-year-old patients with an LDL-C measurement. From 1,589,264 patients available before 2009, 12,823 fulfilled FH-P criteria and 514,176 patients were normolipidemic (LDL-C < 115 mg/dL). In primary prevention, patients with FH-P had incidences of ASCVD and coronary heart disease (CHD) of 14.9/1000 and 5.8/1000 person-years, respectively, compared to 7.1/1000 and 2.1/1000 person-years in the normolipidemic group. FH-P showed hazard ratio (HR) of 7.1 and 16.7 for ASCVD and CHD, respectively, in patients younger than 35 years. In secondary prevention, patients with FH-P had incidences of ASCVD and CHD of 89.7/1000 and 34.5/1000 person-years, respectively, compared to 90.9/1000 and 28.2/1000 person-years in the normolipidemic group (HR in patients younger than 35 years: 2.4 and 6.0). In the statin era, FH-P remains associated with high cardiovascular risk, compared with the normolipidemic population. This excess of risk is markedly high in young individuals.

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Section: Discussionsupporting

confidence: 93%

Incidence of Cardiovascular Disease in Patients with Familial Hypercholesterolemia Phenotype: Analysis of 5 Years Follow-Up of Real-World Data from More than 1.5 Million Patients

Zamora

Plana

Comas-Cufí

et al. 2019

JCM

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“…We determined the observed number of incident CVD events per person-years of follow-up, stratified by sex and age-groups (<30 years, 30 to >50 years and in the over 50 year age-groups). Standardised morbidity ratios (SMbR) were calculated using indirect standardisation, with age and sex-specific CVD incidence rates of the UK primary care non-FH population, as reference rates [2]. We calculated the expected number of CVD events as the number of person-years of follow-up in the SB cohort multiplied by the incidence rate for the comparable age-group and sex in the reference population.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Familial hypercholesterolaemia is an autosomal dominant disorder characterised by lifelong elevated plasma levels of low-density lipoprotein (LDL) cholesterol, which when untreated, leads to increased risk of coronary heart disease (CHD) and premature death [1]. More recently, individuals with FH phenotype in primary care have been shown to have a greatly increased risk of not only CHD, but also stroke and peripheral vascular disease (PVD) [2]. Heterozygous FH affects 1 in 250 to 1 in 300 of the general population but the majority of these individuals are undiagnosed [3,4].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records

et al. 2020

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Background and aims: The UK Simon Broome (SB) familial hypercholesterolaemia (FH) register previously reported 3-fold higher standardised mortality ratio for cardiovascular disease (CVD) in women compared to men from 2009 to 2015. Here we examined sex differences in CVD morbidity in FH by national linkage of the SB register with Hospital Episode Statistics (HES). Methods: Of 3553 FH individuals in the SB register (aged 20-79 years at registration), 2988 (52.5% women) had linked HES records. Standardised Morbidity Ratios (SMbR) compared to an age and sex-matched UK general practice population were calculated [95% confidence intervals] for first CVD hospitalisation in HES (a composite of coronary heart disease (CHD), myocardial infarction (MI), stable or unstable angina, stroke, TIA, peripheral vascular disease (PVD), heart failure, coronary revascularisation interventions). Results: At registration, men had significantly (p < 0.001) higher prevalence of previous CHD (24.8% vs 17.6%), previous MI (13.2% vs 6.3%), and were commenced on lipid-lowering treatment at a younger age than women (37.5 years vs 42.3 years). The SMbR for composite CVD was 6.83 (6.33-7.37) in men and 7.55 (6.99-8.15) in women. In individuals aged 30-50 years, SMbR in women was 50% higher than in men (15.

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“…Adults, 16 years and above, with an established diagnosis of CVD (where CVD is defined as a documented clinical diagnosis of arterial occlusive events, including coronary artery disease, cerebrovascular artery disease and peripheral artery disease (PAD)). 14 15 …”

Section: Methodsmentioning

confidence: 99%

Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models

et al. 2020

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IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.Methods and analysisBibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.Ethics and disseminationEthics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication.PROSPERO registration numberCRD42019149111.

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Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study

Cited by 25 publications

References 34 publications

Incidence of Cardiovascular Disease in Patients with Familial Hypercholesterolemia Phenotype: Analysis of 5 Years Follow-Up of Real-World Data from More than 1.5 Million Patients

Incidence of Cardiovascular Disease in Patients with Familial Hypercholesterolemia Phenotype: Analysis of 5 Years Follow-Up of Real-World Data from More than 1.5 Million Patients

Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records

Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models

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