Risk of Recurrent Coronary Events in Patients With Familial Hypercholesterolemia; A 10-Years Prospective Study

Abstract

Background and Aim: Real world evidence on long term treatment of patients with familial hypercholesterolemia (FH) is important. We studied the effects of intensive lipid lowering medication (LLM) and optimized lifestyle in the study TTTFH–Treat To Target FH.Materials and Methods: Adults with a first known total cholesterol of mean (95% CI) 9.8 mmol/L (9.5, 10.1) were included consecutively in their routine consultation during 2006. Of the patients 86.4% had a pathogenic FH-mutation and the remaining were clinically diagnosed. We included 357 patients and 279 met for follow-up after median 10.0 (min 8.1, max 12.8) years.Results: Mean (95% CI) low density lipoprotein (LDL-C) was reduced from 3.9 (3.8, 4.1) to 3.0 (2.9, 3.2). More men than women used high intensity statin treatment, 85.2 and 60.8%, respectively. Women (n = 129) had higher LDL-C; 3.3 mmol/L (3.0, 3.5), than men; (n = 144) 2.8 mmol/L (2.6, 3.0), p = 0.004. Add-on PCSK9 inhibitors (n = 25) reduced mean LDL-C to 2.0 (1.4, 2.6) mmol/L. At enrollment 57 patients (20.4%) had established atherosclerotic cardiovascular disease (ASCVD), and 46 (80.4%) of them experienced a new event during the study period. Similarly, 222 (79.6%) patients had no detectable ASCVD at enrollment, and 29 of them (13.1%) experienced a first-time event during the study period.Conclusion: A mean LDL-C of 3.0 mmol/L was achievable in FH, treated intensively at a specialized clinic with few users of PCSK9 inhibitors. LDL-C was higher (0.5 mmol/L) in women than in men. In patients with ASCVD at enrollment, most (80.7%) experienced a new ASCVD event in the study period. The FH patients in primary prevention had more moderate CV risk, 13% in ten years.

Efficacy and safety of Qushi Huayu granule for hyperlipidemia: study protocol for a randomized, double-blind, placebo-controlled trial

“…Hyperlipidemia usually refers to elevated serum cholesterol and/or triglyceride [ 5 ] levels due to the disorder of systemic lipids metabolism. Among them, the increase of LDL-C is the main risk factor of atherosclerosis [ 6 , 7 ] leading to coronary artery disease, myocardial infarction(MI), and stroke [ 8 , 9 ]. In addition, studies showed the relationship between the control of blood lipids and the progress of diseases such as osteoporosis [ 10 ], chronic kidney disease [ 11 , 12 ], acute pancreatitis [ 13 ].…”

The risk of various types of cardiovascular diseases in mutation positive familial hypercholesterolemia; a review

“…In the present European guidelines for management of dyslipidemias, FH individuals are categorized as individuals at high-risk of disease by default, and in primary prevention treatment goals are at least a 50% reduction from baseline in LDL-C down to <1.8 mmol/L or <1.4 mmol/L depending on the global risk burden ( Mach et al, 2019 ). However, very few patients with FH + reach treatment target even on maximal treatment with statins and ezetimibe and the risk of ASCVD remain high in FH + compared to controls ( Arnesen et al, 2020 ). Use of PCSK9-inhibitors in addition to statins and ezetimibe can bring LDL-C down in many FH + patients, but its use is limited by high cost ( Attipoe-Dorcoo et al, 2021 ).…”