Sofía Perez-Calahorra1, Martín Laclaustra1, Victoria Marco-Benedí1, Itziar Lamiquiz-Moneo1, Juan Pedro-Botet2, Núria Plana3, Rosa M Sanchez-Hernandez4, Antonio J Amor5, Fátima Almagro6, Francisco Fuentes7, Manuel Suarez-Tembra8, Fernando Civeira9. 1. Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain. 2. Lipid and Vascular Risk Unit, Department of Endocrinology and Nutrition, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Unitat de Medicina Vascular i Metabolism, Hospital Universitari Sant Joan, Institut d'Investigación Sanitaria Pere Virgili (IISPV), CIBERDEM, Reus, Tarragona, Spain. 4. Lipid Unit, Endocrinology Department, Hospital Universitario Insular de Gran Canaria, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de, Gran Canaria, Spain. 5. Lipid Unit, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, CIBEROBN, Barcelona, Spain. 6. Lipid Unit, Hospital Universitario Donostia, San Sebastián, Spain. 7. Lipid Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, CIBEROBN, Universidad de Córdoba, Spain. 8. Lipid Unit, Hospital San Rafael, A Coruña, Spain. 9. Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain. Electronic address: civeira@unizar.es.
Abstract
BACKGROUND AND AIMS: The impact on heterozygous familial hypercholesterolemia (HeFH) health led by high-intensity lipid-lowering therapy (HILLT) is unknown, and the question remains if there is still an unacceptably high residual risk to justify treatment with new lipid-lowering drugs. METHODS: This observational, retrospective, multicenter, national study in Spain, whose information was obtained from a national dyslipemia registry, was designed to establish the current prevalence of cardiovascular disease (CVD) in HeFH and to define the impact of HILLT on CVD in this population. Odds were estimated using several logistic regression models with progressive adjustment. RESULTS: 1958 HeFH, mean age 49.3 ± 14.3 years, were included in the analysis. At inclusion in the registry, 295 patients (15.1%) had suffered CVD and 164 (55.6%) had suffered the first event before the onset lipid-lowering treatment. Exposition to treatment associated more than ten times lower odds for CVD than in subjects naïve to treatment (OR 0.085, 95% CI 0.063-0.114, p < 0.001). A first CVD event after a mean treatment period of 9.1 ± 7.2 years occurred in 131 out of 1615 (8.1%) HeFH subjects, and 115 (87.8%) of them were on HILLT. CONCLUSIONS: Current prevalence of CVD among HeFH is one third of that reported before the statins era. Early initiation and prolonged lipid-lowering treatment was associated with a reduction in CVD. New cases of CVD, in spite of HILLT, appeared mostly among patients accumulating risk factors and probably they may be considered for further lipid-lowering drugs.
BACKGROUND AND AIMS: The impact on heterozygous familial hypercholesterolemia (HeFH) health led by high-intensity lipid-lowering therapy (HILLT) is unknown, and the question remains if there is still an unacceptably high residual risk to justify treatment with new lipid-lowering drugs. METHODS: This observational, retrospective, multicenter, national study in Spain, whose information was obtained from a national dyslipemia registry, was designed to establish the current prevalence of cardiovascular disease (CVD) in HeFH and to define the impact of HILLT on CVD in this population. Odds were estimated using several logistic regression models with progressive adjustment. RESULTS: 1958 HeFH, mean age 49.3 ± 14.3 years, were included in the analysis. At inclusion in the registry, 295 patients (15.1%) had suffered CVD and 164 (55.6%) had suffered the first event before the onset lipid-lowering treatment. Exposition to treatment associated more than ten times lower odds for CVD than in subjects naïve to treatment (OR 0.085, 95% CI 0.063-0.114, p < 0.001). A first CVD event after a mean treatment period of 9.1 ± 7.2 years occurred in 131 out of 1615 (8.1%) HeFH subjects, and 115 (87.8%) of them were on HILLT. CONCLUSIONS: Current prevalence of CVD among HeFH is one third of that reported before the statins era. Early initiation and prolonged lipid-lowering treatment was associated with a reduction in CVD. New cases of CVD, in spite of HILLT, appeared mostly among patients accumulating risk factors and probably they may be considered for further lipid-lowering drugs.
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