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BMJ. 2008 Nov 11;337:a2423. doi: 10.1136/bmj.a2423.

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

Author information

1
Department of Internal Medicine, Erasmus University Medical Centre, PO box 2040, 3000 CA Rotterdam, Netherlands.

Abstract

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.

PMID:
19001495
PMCID:
PMC2583391
DOI:
10.1136/bmj.a2423
[Indexed for MEDLINE]
Free PMC Article

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