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