Highlights
- •A small proportion of familial hypercholesterolemia (FH) patients achieved the recommended LDL-Ch treatment targets.
- •High intensity statin was prescribed in only 17.9% of FH patients.
- •9.6% of FH patients developed new atherosclerotic cardiovascular disease (ASCVD) during the 3 years of statin treatment.
- •New onset diabetes was diagnosed in 6.4% of statin treated FH patients.
Abstract
Background and aims
Despite the use of statins, familial hypercholesterolemia (FH) patients often have
increased LDL-cholesterol (Ch) and high risk for atherosclerotic cardiovascular disease
(ASCVD). This study aimed to analyze the effect of statin therapy on attainment of
LDL-Ch treatment targets and appearance of new ASCVD and diabetes in FH patients.
Methods
This study is a retrospective analysis of data from medical records of 302 FH patients
treated continuously with statins during 3 years. At baseline and once yearly, anthropometric
measurements, lipids (total Ch, LDL-Ch, HDL-Ch, triglycerides, apoliporotein A1 and
B), fasting plasma glucose, and insulin were determined.
Results
In FH patients, high intensity statin was prescribed only in 17.9% of cases. LDL-Ch
levels were significantly lower after 3 years of statin treatment (3.61 ± 1.19 mmol/l)
vs. baseline (4.51 ± 1.69 mmol/l; p < 0.01), but only 6.9% of FH patients reached the recommended ≥50% LDL-Ch reduction
and 16.2% attained the LDL-Ch <2.6 mmol/l target. Simultaneously, 9.6% of FH patients
developed new ASCVD, with lower HDL-Ch after 3 years of statin treatment than in those
who remained free of ASCVD. In addition, we observed new onset diabetes in 6.4% of
FH patients who were more obese, older and with higher fasting glucose at baseline
than FH patients free of diabetes, regardless of the type of statin.
Conclusions
These results imply that only a small proportion of FH patients achieved the recommended
LDL-Ch treatment targets, mostly due to the use of low statin dose and infrequent
implementation of high-intensity statin treatment, which altogether could not prevent
the increase in residual cardiovascular risk.
Keywords
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References
- Familiar hypercholesterolemia.Curr. Opin. Cardiol. 2014; 29: 381-388
- Familial hypercholesterolemia-epidemiology, diagnosis, and screening.Curr. Atherosclerosis Rep. 2015; 17: 482
- Prevalence of familial hypercholesterolemia: a meta-analysis of six large, observational, population-based studies in Poland.Arch. Med. Sci. 2016; 12: 687-696
- Clinical implications of the molecular basis of familial hypercholesterolemia and other inherited dyslipidemias.Circulation. 2011; 123: 1153-1155
- Effect of lipid-lowering treatment on natural history of heterozygous familial hypercholesterolemia in past three decades.Am. J. Cardiol. 2011; 108: 223-226
- Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society.Eur. Heart J. 2013; 34: 3478-3490
- Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society.Eur. Heart J. 2014; 35: 2146-2157
- ESC/EAS guidelines for the management of dyslipidaemias.Eur. Heart J. 2016; 37 (2016): 2999-3058
- Evaluation of cholesterol lowering treatment of patients with familial hypercholesterolemia: a large cross-sectional study in The Netherlands.Atherosclerosis. 2010; 209: 189-194
- Attainment of LDL-cholesterol treatment goals in patients with familial hypercholesterolemia: 5-year SAFEHEART registry follow-up.J. Am. Coll. Cardiol. 2016; 67: 1278-1285
- Treatment gaps in adults with heterozygous familial hypercholesterolemia in the United States: data from the CASCADE-FH registry.Circ Cardiovasc Genet. 2016; 9: 240-249
- Health Statistical Yearbook of Republic of Serbia 2016, Belgrade.2017 (available online)
- Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: rationale and design of the global EAS Familial Hypercholesterolaemia Studies Collaboration.Atherosclerosis Suppl. 2016; 22: 1-32
- Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.Diabetologia. 1985; 28: 412-419
- Use of lipid-modifying therapy and LDL-C goal attainment in a high-cardiovascular-risk population in The Netherlands.Clin. Therapeut. 2017; 39: 819-827
- Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish familial hypercholesterolemia longitudinal cohort study (SAFEHEART).Lipids Health Dis. 2011; 10: 94
- Evaluation of cholesterol lowering treatment of patients with familial hypercholesterolemia: a large cross-sectional study in The Netherlands.Atherosclerosis. 2010; 209: 189-194
- Severe heterozygous familial hypercholesterolemia and risk for cardiovascular disease: a study of a cohort of 14,000 mutation carriers.Atherosclerosis. 2014; 233: 219-223
- Cardiovascular disease in familial hypercholesterolaemia: influence of low-density lipoprotein receptor mutation type and classic risk factors.Atherosclerosis. 2008; 200: 315-321
- Residual macrovascular risk in 2013: what have we learned?.Cardiovasc. Diabetol. 2014; 24: 26
- Cardiovascular risk in patients with familial hypercholesterolemia using optimal lipid-lowering therapy.J Clin Lipidol. 2018; 12: 409-416
- Cardiovascular disease in familial hypercholesterolemia: validation and refinement of the Montreal-FH-SCORE.J Clin Lipidol. 2017; 11: 1161-1167
- Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.Lancet. 2010; 375: 735-742
- Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis.J. Am. Med. Assoc. 2011; 305: 2556-2564
- Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial.Lancet. 2012; 380: 565-571
- Effect of LDL cholesterol, statins and presence of mutations on the prevalence of type 2 diabetes in heterozygous familial hypercholesterolemia.Sci. Rep. 2017; 7: 5596
Article info
Publication history
Accepted:
August 21,
2018
Received in revised form:
June 13,
2018
Received:
March 28,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
