Format

Send to

Choose Destination
Atherosclerosis. 2019 Oct;289:85-93. doi: 10.1016/j.atherosclerosis.2019.08.007. Epub 2019 Aug 19.

Longitudinal low density lipoprotein cholesterol goal achievement and cardiovascular outcomes among adult patients with familial hypercholesterolemia: The CASCADE FH registry.

Author information

1
Oregon Health and Science University, Portland, OR, USA.
2
The FH Foundation, Pasadena, CA, USA. Electronic address: sg@thefhfoundation.org.
3
Lancaster General Health/Penn Medicine, Lancaster, PA, USA.
4
Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
5
Lenox Hill Hospital, Northwell Health, New York, NY, USA.
6
Duke Clinical Research Institute, Durham, NC, USA.
7
The FH Foundation, Pasadena, CA, USA. Electronic address: irishommeskindt@hotmail.nl.
8
Central Maine Heart and Vascular Institute/Central Maine Medical Center (CMMC), Lewiston, ME, USA.
9
Massachusetts General Hospital, Boston, MA, USA.
10
The FH Foundation, Pasadena, CA, USA.
11
Johns Hopkins University Baltimore, MD, USA.
12
The Ohio State University Medical Center, Columbus, OH, USA.
13
UT Southwestern Medical Center, Dallas, TX, USA.
14
Mayo Clinic, Rochester, MN, USA.
15
NYU Langone Medical Center, New York, NY, USA.
16
Duke University Medical Center, Durham, NC, USA.
17
Hartford Hospital, Hartford, CT, USA.
18
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
19
University of Pennsylvania, Philadelphia, PA, USA.
20
Vanderbilt University School of Medicine, Nashville, TN, USA.
21
University of Kansas Medical Center, Kansas City, KS, USA.
22
Stanford University, Stanford, CA, USA.

Abstract

BACKGROUND AND AIMS:

There are limited data from the US on outcomes of patients in specialty care for familial hypercholesterolemia (FH).

METHODS:

CASCADE FH Registry data were analyzed to assess longitudinal changes in medication usage, in low density lipoprotein cholesterol (LDL-C) levels, and the rate of major adverse cardiovascular events (MACE (myocardial infarction, coronary revascularization, stroke or transient ischemic attack) in adults with FH followed in US specialty clinics.

RESULTS:

The cohort consisted of 1900 individuals (61% women, 87% Caucasian), with mean age of 56 ± 15 years, 37% prevalence of ASCVD at enrollment, mean pretreatment LDL-C 249 ± 68 mg/dl, mean enrollment LDL-C 145 mg/dl and 93% taking lipid lowering therapy. Over follow up of 20 ± 11 months, lipid lowering therapy use increased (mean decrease in LDL-C of 32 mg/dl (p < 0.001)). Only 48% of participants achieved LDL-C < 100 mg/dl and 22% achieved LDL-C < 70 mg/dl; ASCVD at enrollment was associated with greater likelihood of goal achievement. MACE event rates were almost 6 times higher among patients with prior ASCVD compared to those without (4.6 vs 0.8/100 patient years). Also associated with incident MACE were markers of FH severity and conventional ASCVD risk factors.

CONCLUSIONS:

With care in FH specialized clinics, LDL-C decreased, but LDL-C persisted >100 mg/dl in 52% of patients. High ASCVD event rates suggest that adults with FH warrant designation as having an ASCVD risk equivalent. Earlier and more aggressive therapy of FH is needed to prevent ASCVD events.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01960244.

KEYWORDS:

Cardiovascular disease; Familial hypercholesterolemia; LDL cholesterol goal achievement; Low density lipoprotein (LDL) cholesterol; PCSK9 inhibitor

Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center