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Statin therapy lowers CAD, mortality risk in familial hypercholesterolemia
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Moderate- to high-intensity statin therapy lowered the risk for CAD and mortality for patients with heterozygous familial hypercholesterolemia, according to findings published in the Journal of the American College of Cardiology.
“The evidence is now overwhelming that [familial hypercholesterolemia] is highly morbid yet underappreciated, underdiagnosed and undertreated,” Joshua W. Knowles, MD, PhD, from the division of cardiovascular medicine at Stanford University, wrote in a related editorial. “The terrible irony, strongly emphasized by this study, is that, if identified early enough and treated appropriately, the morbidity and mortality of [familial hypercholesterolemia] can be markedly if not totally ameliorated.”
Joshua W. Knowles
Joost Besseling, MD, from the department of vascular medicine, Academic Medical Center, Amsterdam, and colleagues analyzed data from 1,559 adult patients in Holland who were screened for heterozygous familial hypercholesterolemia (FH) and were free of CAD at baseline from 1994 to April 2013. The primary outcome was the composite of MI, coronary revascularization and death due to any cause. The efficacy of statins was measured with a model corrected for use of other lipid-lowering agents, thrombocyte aggregation inhibitors and medication for diabetes or hypertension.
Among the cohort, the HR of statin use for CAD and all-cause mortality was 0.56 (95% CI, 0.33-0.96) after applying inverse probability for treatment weighting and adjusting for other medications.
Patient prescriptions included simvastatin 40 mg (23.1%) and atorvastatin 40 mg (22.8%). Those using statins (n = 1,041) experienced 89 CAD events and 17 deaths during 11,674 person-years of follow-up, whereas statin nonusers (n = 518) had 89 CAD events and 17 deaths in 4,892 person-years (P < .001).
“We must turn our attention to the critical task of assuring that all individuals with FH have the opportunity for optimal care,” Knowles wrote. “We need to continue to educate providers and patients about FH and combat misinformation [about statins].” – by James Clark
Disclosure: Besseling reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures. Knowles reports receiving an institutional research grant from Amgen.
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