Familial hypercholesterolaemia patients may develop CVD despite lipid lowering therapy

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Takeaway

  • In this study involving patients with familial hypercholesterolaemia, 12% developed cardiovascular disease (CVD) despite of maximum tolerated lipid lowering therapy (LLT).
  • Associated risk factors were smoking, hypertension, low-density lipoprotein-cholesterol (LDL-C) levels and high-density lipoprotein-cholesterol (HDL-C) levels.
  • Quite a few patients developed subsequent events where smoking again appeared to be a risk factor.

Why this matters

  • Study recommends intensified lifestyle intervention with emphasis on smoking and hypertension in addition to focus on lipid parameters for reduced CVD in this patient category.

Study design

  • 821 patients (median age, 47.4 years) with heterozygous familial hypercholesterolaemia who were treated with LLT for a median period of 9.5 years evaluated.
  • Funding: Sanofi-Aventis.

Key results

  • 12% patients developed ≥1 CVD in 8538 statin-treated person years despite LLT.
  • Smoking (OR, 4.24; 95% CI, 2.14-8.37), hypertension (OR, 2.95; 95% CI, 1.68-5.18), CVD before LLT initiation (OR, 2.47; 95% CI, 1.34-4.57) and a family history of premature CVD (OR, 1.85; 95% CI, 1.10-3.11) increased CVD risk.
  • Higher LDL-C (OR, 3.64; 95% CI, 1.60-8.29) and lower HDL-C (OR, 4.27; 95% CI, 2.18-8.36) levels were other risk factors.
  • 30% patients developed subsequent CVD after a median of 5.7 years, and were more often current smokers (P=.01) or had hypertension history (P=.06).

Limitations

  • Single-centre study.
  • Lipoprotein(a) levels unavailable for many patients.