Coronary heart disease mortality in treated familial hypercholesterolaemia:Update of the UK Simon Broome FH register

Background and aims: Patients with familial hypercholesterolaemia (FH) have an elevated risk of coronary heart disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992, before lipid-lowering therapy with statins was used routinely, and in the periods 1992–2008 and 2008–2016. Methods: 1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20–79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2016 for 67,060 person-years. The CHD standardised mortality ratio (SMR) compared to the po... Mehr ...

Dokumenttyp: Artikel
Erscheinungsdatum: 2018
Reihe/Periodikum: The Simon Broome Familial Hyperlipidaemia Register Group 2018 , ' Coronary heart disease mortality in treated familial hypercholesterolaemia : Update of the UK Simon Broome FH register ' , Atherosclerosis , vol. 274 , pp. 41-46 . https://doi.org/10.1016/j.atherosclerosis.2018.04.040
Schlagwörter: Cancer mortality / Coronary mortality / Dutch lipid clinic network score / Heterozygous familial hypercholesterolemia
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-29021697
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : https://research.manchester.ac.uk/en/publications/06c2479f-86f5-4ade-ac44-af53f9183a02

Background and aims: Patients with familial hypercholesterolaemia (FH) have an elevated risk of coronary heart disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992, before lipid-lowering therapy with statins was used routinely, and in the periods 1992–2008 and 2008–2016. Methods: 1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20–79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2016 for 67,060 person-years. The CHD standardised mortality ratio (SMR) compared to the population in England and Wales was calculated (with 95% Confidence intervals). Results: There were 585 deaths, including 252 from CHD. Overall, the observed 2.4-fold excess coronary mortality for treated DFH post-1991 was significantly higher than the 1.78 excess for PFH (35% 95% CI 3%–76%). In patients with DFH and established coronary disease, there was a significant excess coronary mortality in all time periods, but in men it was reduced from a 4.83-fold excess (2.32–8.89) pre-1992 to 4.66 (3.46–6.14) in 1992–2008 and 2.51 (1.01–5.17) post-2008, while in women the corresponding values were 7.23 (2.65–15.73), 4.42 (2.70–6.82) and 6.34 (2.06–14.81). Primary prevention in men with DFH resulted in a progressive reduction in coronary mortality over the three time-periods, with no excess mortality evident post-2008 (0.89 (0.29–2.08)), although in women the excess persisted (post-2008 3.65 (1.75–6.72)). Conclusions: The results confirm the benefit of statin treatment in reducing CHD mortality, but suggest that FH patients with pre-existing CHD and women with FH may not be treated adequately.