Intensifying the treatment of familial hypercholesterolemia—the experience of a single center in Eastern Bulgaria

Introduction: Familial hypercholesterolemia (FH) is an established risk factor for the development of atherosclerotic cardiovascular diseases (CVD), which determines early morbidity and mortality. Intensive reduction of the high levels of low-density lipoprotein cholesterol (LDL-c) reduces the incidence of CVD.Aim: The aim of this article is to analyze changes in lipid levels after intensification of the treatment of patients with familial hypercholesterolemia.Participants and Methods: Lipid levels of 59 patients with familial hypercholestrolemia from Eastern Bulgaria were studied with the aim of optimizing the management at an FH treatment center at St. Marina University Hospital, Varna. The period covered was from October 2017 to July 2020. The diagnosis of FH was determined as probable or certain according to the Dutch Lipid Clinics Network (DLCN) with a score of ≥ 6 points. After evaluation of the inclusion criteria for initiating treatment with evolocumab, all patients were monitored every 6 months for their lipid status. Baseline demographic characteristics and changes in the levels of laboratory tests for total cholesterol, LDL-c, and HDL cholesterol (HDL-c) were analyzed. A t-test for grouped pairs was used to estimate the difference from the baseline.Results: Of all 59 who passed through the center, the majority were men (58%). The mean age was 57.66 ± 9.57 years, from 37 to 76 years. A total of 54% had ischemic heart disease, 30.5% had survived a myocardial infarction, and 12% had a previous stroke. The mean baseline of total cholesterol was 8.23 ± 3.65 mmol/L, that of LDL cholesterol was 5.31 ± 1.95 mmol/L, and that of HDL-c was 1.25 ± 0.4 mmol/L. After 6 months, LDL-c levels dropped down to an average of 2.46 ± 1.59 mmol/L (p <0.0001) and persisted for 2.5 years after onset. The same trend was observed for total cholesterol. Achieving different target levels of LDL-c was reached as early as the 6th month in 76% and 56% of the treated, respectively.Conclusion: The use of evolocumab in addition to statin therapy leads to a significant and lasting reduction in total and LDL cholesterol in patients with FH. A significant number of them achieve targeted levels of LDL-c, which reduces the risk of new cardiovascular events