Effect of lipid-lowering treatment in cardiovascular disease prevalence in familial hypercholesterolemia

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

Prevalence of metabolic syndrome and cardiovascular disease in a hypertriglyceridemic population

BACKGROUND: We aim to study the prevalence of metabolic syndrome (MS), hypertension and diabetes, and their relationship to cardiovascular disease in subjects with hypertriglyceridemia. METHODS: This is an observational cross-sectional study, uncontrolled and multicentre study. Selected subjects were patients with hypertriglyceridemia (triglycerides, TG, ≥ 200 mg/dl) visited in the Lipid Units of the Spanish Arteriosclerosis Society who met the inclusion criteria. Prevalence of MS (ATPIII and IDF criteria, MS-ATPIII or MS-IDF), hypertension and diabetes were studied. The presence of cardiovascular disease (CVD) was also determined. RESULTS: The results showed that individuals referred for hypertriglyceridemia had a high prevalence of MS-ATPIII 79.6% and MS-IDF 75.2%. The prevalence of MS was independent of plasma triglyceride levels. The prevalence of hypertension and diabetes were 50.9% and 33.5%, respectively. The prevalence of diabetes was double than in the general population. The prevalence of CVD was 14.6%. 95.9% of CVD events were found in patients with MS-ATPIII and only 4.1% in the group without MS-ATPIII, significant differences. CONCLUSIONS: Hypertriglyceridemia is associated to the metabolic syndrome and diabetes, as well as the risk of CVD, independently of the levels of triglycerides. Hypertriglyceridemia may be an important marker in the screening of these severe metabolic and vascular abnormalities

Effect of lipid-lowering treatment in cardiovascular disease prevalence in familial hypercholesterolemia.

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. 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. 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  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