Key result
Statin-ezetimibe combination linked to ~60% higher rate of achieving 50% LDLc reduction in FH.
Why the study?
The referral rate and cardiovascular risk factor control in patients evaluated for familial hypercholesterolemia were not well characterized to support the need for specialized lipid units.
Cross-Sectional (n=118)
No
Absolute Event Rate: 73% vs 45.5%
p-value: p=0.003
Patients with potential familial hypercholesterolemia referred to a specialized lipid unit have high rates of uncontrolled modifiable risk factors, highlighting the need for intensive combination lipid-lowering therapy.
May support lipid units for FH referrals with poor control; leaves open CV outcome impact in observational data.
BACKGROUND: The challenging rigorous management of hypercholesterolemia promotes referral to specialized units. This study explored the need, based on referral rate and cardiovascular (CV) risk factor control in patients evaluated for familial hypercholesterolemia (FH), for a lipid unit (LU). METHODS: Over a four-year period, 340 referrals to our unit were analyzed to establish the lipid disorder referral rate. Moreover, 118 patients referred for potential FH during the period 2010-2018 (52.4 ± 13.9 years, 47.5% male, Caucasian, 26.3% obese, 33.1% smokers and 51.7% with some glycaemic alteration) were investigated. The Dutch Lipid Clinic Network (DLCN) score, type and dose of lipid-lowering drugs, lipid profile including lipoprotein (a) (Lp(a)) and the presence of plaques with carotid ultrasound (CU) were recorded. RESULTS: Lipids represented 6.2% of referrals (38 patient-years) requiring a 2-3 h weekly monographic outpatient consultation. The potential FH sample displayed a DLCN score ≥ 6 in 78% and modifiable CV risk factors in 51%. Only 22% achieved tight disease control despite intensive treatment. The statin-ezetimibe combination treatment group achieved better goals (73.0% vs. 45.5%, P = 0.003), and the rosuvastatin group had a higher proportion of prediabetes (60.9% vs. 39.1%, P = 0.037). Neither CU plaque presence nor Lp(a) > 50 mg/dL was linked with established CV disease patients, but higher Lp(a) concentrations were detected between them (102.5 (26.3-145.8) vs. 25.0 (13.0-52.0) mg/dL, P = 0.012). CONCLUSIONS: The referral rate, degree of control, and proportion of modifiable CV risk factors in FH patients demonstrate the need for LU in our area as well as optimize control and treatment.
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Enric Serra‐Planas (2023) conducted a cross-sectional in Familial hypercholesterolemia (n=118). Statin-ezetimibe combination vs. No combination treatment was evaluated on Achievement of 50% reduction from initial LDLc concentrations (p=0.003). Among patients evaluated for familial hypercholesterolemia, treatment with a statin-ezetimibe combination was associated with a higher rate of achieving a 50% LDLc reduction compared to no combination (73.0% vs. 45.5%, p=0.003).
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