Efficacy of statins in familial hypercholesterolaemia: a long term cohort study

By J. Versmissen, Daniëlla M. Oosterveer, M. Yazdanpanah, J. Defesche, D. Basart, A. Liem, J. Heeringa, J. Witteman, P. Lansberg, J. Kastelein and 1 more. British medical journal, 2008

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Objective To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design Cohort study with a mean follow-up of 8.5 years. Setting 27 outpatient lipid clinics. Subjects 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures Risk of coronary heart disease in treated and “untreated” (delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results In January 1990, 413 (21%) of the patients had started statin treatment, and during follow-up another 1294 patients (66%) started after a mean delay of 4.3 years. Most patients received simvastatin (n=1167, 33 mg daily) or atorvastatin (n=211, 49 mg daily). We observed an overall risk reduction of 76% (hazard ratio 0.24 (95% confidence interval 0.18 to 0.30), P<0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age-matched sample from the general population (hazard ration 1.44 (0.80 to 2.60), P=0.23). Conclusion Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population.

Subfields: Cancer Research, Endocrinology, Diabetes and Metabolism, Surgery

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Citations in the corpus

The Agenda for Familial Hypercholesterolemia: A Scientific Statement From the American Heart Association. (2015, background): “prestatin and poststatin eras demonstrate lower event rates in FH patients in the statin era.(10,11) However, long-term questions”
Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients: clinical guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. (2011, result): “A Dutch study evaluating a cohort of over 2100 FHpatientswho did not haveCVD in 1990 (prior to availability of the first statin) found that in those who later took statin therapy, the risk of myocardial infarction was reduced by 76% over the next 81 years to a rate similar to that of an age-matched ”
Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease (2013, background): “Other studies also support massive undertreatment of individuals with FH.(3,12,13)”
Familial hypercholesterolemia (2011, neutral): “individuals with heterozygous FH (4), early identification and intervention during childhood may greatly improve outcomes in adulthood.”