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Familial hypercholesterolemia may be risk equivalent to ASCVD
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Patients with familial hypercholesterolemia who were treated in U.S. specialty clinics had a harder time achieving LDL less than 100 mg/dL than those who had atherosclerotic CVD at the start of lipid-lowering therapy.
According to findings published in Atherosclerosis, among a cohort of patients from the CASCADE FH Registry with familial hypercholesterolemia (FH; 37% with ASCVD at baseline), researchers observed that although lipid-lowering therapy use increased (mean decrease in LDL of 32 mg/dL; P < .001), just 48% of participants achieved LDL less than 100 mg/dL, and only 22% achieved LDL less than 70 mg/dL during a mean 20-month follow-up.
Moreover, ASCVD events occurred in 3.6% of the cohort, suggesting an annual event rate of 2.2 per 100 patient-years. Researchers found that patients with ASCVD at baseline had a 5.6 times greater risk for CAD compared with those without prior ASCVD (4.6 per 100 patient-years in the ASCVD group vs. 0.82 per 100 patient-years in the non-ASCVD group; P < .0001). The researchers noted that the majority of incident events were CAD rather than cerebrovascular events.
“These data from the CASCADE FH Registry demonstrate that individuals with FH are truly a vulnerable, high-risk population for future heart and stroke events, despite being on multiple treatments,” P. Barton Duell, MD, professor of medicine in the division of cardiovascular medicine at Oregon Health & Science University, Portland, said in a press release. “These data suggest that FH patients without known heart disease may actually have a risk of heart attack that is comparable to the risk in patients without FH who have already had a heart attack. Most individuals with FH will require multiple medications to adequately lower the LDL level to below goal. Adding additional medications to achieve an LDL level that can help prevent a heart attack, particularly for those who already have heart disease, needs to become the standard of care.”
In other findings, patients with ASCVD at enrollment were found to be more likely to achieve LDL less than 100 mg/dL and less than 70 mg/dL compared with patients who did not have ASCVD at the time of enrollment (LDL < 100 mg/dL, 37.2% vs. 23.8%; P < .0001; LDL < 70 mg/dL, 18.4% vs. 6.5%; P < .0001).
Additionally, a majority of patients with LDL greater than 200 mg/dL had a reduction of approximately 60%.
“These 5 years of data from across the United States underscore the impact of life-long exposure to LDL cholesterol in the FH population,” Katherine A. Wilemon, founder and CEO of the FH Foundation, said in the release. “The vast majority of individuals with FH in the United States continue to live without a diagnosis, barring them from the opportunity to receive appropriate care. Finding these individuals and initiating intensive treatment early in life is critical to preventing heart disease.”
Using data acquired from the CASCADE FH Registry, researchers assessed longitudinal changes in medication use, LDL and incidence of major adverse CV events that include, MI, coronary revascularization, stroke or transient ischemic attack in a cohort of adult patients with HF (n = 1,900; 61% women; 87% white; mean age, 56 years; mean enrollment LDL, 145 mg/dL) who were treated in U.S. specialty clinics.
“The opportunity to improve FH care exists now. Studies to determine the optimal LDL goal in patients with FH for lifelong ASCVD prevention should be undertaken,” the researchers wrote. “New medications, both available and in development, allow for the possibility of more effective lifetime control of LDL. Increased awareness, the availability or genetic testing, and screening for FH in childhood and young adulthood should help facilitate earlier initiation of treatment and improved outcomes.” – by Scott Buzby
Disclosure s : Duell reports he received institutional research grants from Esperion, Regeneron and Retrophin and is consultant and/or advisory board member of Akcea, AstraZeneca, Esperion, Regeneron, RegenxBio and Retrophin. Please see the study for all other authors’ relevant financial disclosures. The CASCADE FH Registry received financial support from FH Foundation donors and grants from Amgen, Regeneron-Sanofi and The Medicines Company.
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