Coronary heart disease mortality in severe vs. non-severe familial hypercholesterolaemia in the Simon Broome Register.
Adult
Aged
Biomarkers
/ blood
Cholesterol, LDL
/ blood
Coronary Disease
/ diagnosis
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ therapeutic use
Hyperlipoproteinemia Type II
/ diagnosis
Male
Middle Aged
PCSK9 Inhibitors
Prognosis
Proprotein Convertase 9
/ metabolism
Prospective Studies
Registries
Risk Assessment
Risk Factors
Serine Endopeptidases
/ therapeutic use
Severity of Illness Index
United Kingdom
/ epidemiology
Young Adult
Coronary mortality
Severe heterozygous familial hypercholesterolemia
Journal
Atherosclerosis
ISSN: 1879-1484
Titre abrégé: Atherosclerosis
Pays: Ireland
ID NLM: 0242543
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
24
08
2018
revised:
15
10
2018
accepted:
08
11
2018
pubmed:
22
11
2018
medline:
14
4
2020
entrez:
22
11
2018
Statut:
ppublish
Résumé
The International Atherosclerosis Society (IAS) has proposed that patients with "severe" FH (SFH) would warrant early and more aggressive cholesterol-lowering treatment such as with PCSK9 inhibitors. SFH is diagnosed if LDL-cholesterol (LDLC) > 10 mmol/L, or LDLC >8.0 mmol/L plus one high-risk feature, or LDLC >5 mmol/L plus two high-risk features. Here we compare CHD mortality in SFH and non-SFH (NSFH) patients in the UK prospective Simon Broome Register since 1991, when statin use became routine. 2929 definite or possible PFH patients (51% women) aged 20-79 years were recruited from 21 UK lipid clinics and followed prospectively between 1992 and 2016. The excess CHD standardised mortality ratio (SMR) compared to the England and Wales population was calculated (with 95% confidence intervals). 1982 (67.7%) patients met the SFH definition. Compared to the non-SFH, significantly (p < 0.001) more SFH patients had diagnosed CHD at baseline (24.6% vs. 17.5%), were current smokers (21.9% vs 10.2%) and had a BMI > 30 kg/m CHD mortality remains elevated in treated FH, especially for SFH, emphasising the importance of optimal lipid-lowering and management of other risk factors.
Sections du résumé
BACKGROUND AND AIMS
The International Atherosclerosis Society (IAS) has proposed that patients with "severe" FH (SFH) would warrant early and more aggressive cholesterol-lowering treatment such as with PCSK9 inhibitors. SFH is diagnosed if LDL-cholesterol (LDLC) > 10 mmol/L, or LDLC >8.0 mmol/L plus one high-risk feature, or LDLC >5 mmol/L plus two high-risk features. Here we compare CHD mortality in SFH and non-SFH (NSFH) patients in the UK prospective Simon Broome Register since 1991, when statin use became routine.
METHODS
2929 definite or possible PFH patients (51% women) aged 20-79 years were recruited from 21 UK lipid clinics and followed prospectively between 1992 and 2016. The excess CHD standardised mortality ratio (SMR) compared to the England and Wales population was calculated (with 95% confidence intervals).
RESULTS
1982 (67.7%) patients met the SFH definition. Compared to the non-SFH, significantly (p < 0.001) more SFH patients had diagnosed CHD at baseline (24.6% vs. 17.5%), were current smokers (21.9% vs 10.2%) and had a BMI > 30 kg/m
CONCLUSIONS
CHD mortality remains elevated in treated FH, especially for SFH, emphasising the importance of optimal lipid-lowering and management of other risk factors.
Identifiants
pubmed: 30458964
pii: S0021-9150(18)31469-2
doi: 10.1016/j.atherosclerosis.2018.11.014
pmc: PMC6403443
pii:
doi:
Substances chimiques
Biomarkers
0
Cholesterol, LDL
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
PCSK9 Inhibitors
0
PCSK9 protein, human
EC 3.4.21.-
Proprotein Convertase 9
EC 3.4.21.-
Serine Endopeptidases
EC 3.4.21.-
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
207-212Subventions
Organisme : Medical Research Council
ID : MR/K023667/1
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG3008
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG008/08
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
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