Open AccessPrevalence and pharmacologic management of familial hypercholesterolemia in an unselected contemporary cohort of patients with stable coronary artery disease
Author(s) -
De Luca Leonardo,
Arca Marcello,
Temporelli Pier L.,
Colivicchi Furio,
Gonzini Lucio,
Lucci Donata,
Bosco Biagio,
Callerame Mariella,
Lettica Giulio V.,
Di Lenarda Andrea,
Gulizia Michele M.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23031
Subject(s) - medicine , familial hypercholesterolemia , ezetimibe , coronary artery disease , cohort , population , statin , prospective cohort study , gastroenterology , cholesterol , environmental health
Familial hypercholesterolemia (FH) is an inherited disorder characterized by elevated plasma levels of low‐density lipoprotein cholesterol (LDL‐C) associated with premature cardiovascular disease. Methods Using the data from the START (STable Coronary Artery Diseases RegisTry) study, a nationwide, prospective survey on patients with stable coronary artery disease (CAD), we described prevalence and lipid lowering strategies commonly employed in these patients. The study population was divided into “definite/probable FH,” defined as a Dutch Lipid Clinic Network (DLCN) score ≥6, “possible FH” with DLCN 3‐5, and “unlikely FH” in presence of a DLCN <3. Results Among the 4030 patients with the DLCN score available, 132 (3.3%) were classified as FH (2.3% with definite/probable and 1.0% with possible FH) and 3898 (96.7%) had unlikely FH. Patients with both definite/probable and possible FH were younger compared to patients not presenting FH. Mean on‐treatment LDL‐C levels were 107.8 ± 41.5, 84.4 ± 40.9, and 85.8 ± 32.3 ( P < 0.0001) and a target of ≤70 mg/dL was reached in 10.9%, 30.0%, and 22.0% ( P < 0.0001) of patents with definite/probable, possible FH, and unlikely FH, respectively. Statin therapy was prescribed in 85 (92.4%) patients with definite/probable FH, in 38 (95.0%) with possible FH, and in 3621 (92.9%) with unlikely FH ( P = 0.86). The association of statin and ezetimibe, in absence of other lipid‐lowering therapy, was more frequently used in patients with definite/probable FH compared to patients without FH (31.5% vs 17.5% vs 9.5%; P < 0.0001). Conclusions In this large cohort of consecutive patients with stable CAD, FH was highly prevalent and generally undertreated with lipid lowering therapies.