Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)
Por:
Mata, N, Alonso, R, Badimon, L, Padro, T, Fuentes, F, Muniz, O, Perez-Jimenez, F, Lopez-Miranda, J, Diaz, JL, Vidal, JI, Barba, A, Piedecausa, M, Sanchez, JF, Irigoyen, L, Guallar, E, Ordovas, JM, Mata, P
Publicada:
10 jun 2011
Resumen:
Aim: Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART.
Methods and Results: A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe.
Conclusion: Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.
Filiaciones:
Mata, N:
Madrid Hlth Author, Dept Epidemiol, Madrid, Spain
Fdn Hipercolesterolemia Familiar, Madrid, Spain
Alonso, R:
IIS Fdn Jimenez Diaz, Dept Internal Med, Madrid, Spain
Badimon, L:
Hosp Santa Creu & Sant Pau, Ctr Invest Cardiovasc CSIC ICCC, Barcelona, Spain
IIB St Pau, Barcelona, Spain
ISC III, CIBEROBN, Barcelona, Spain
Padro, T:
Hosp Santa Creu & Sant Pau, Ctr Invest Cardiovasc CSIC ICCC, Barcelona, Spain
IIB St Pau, Barcelona, Spain
ISC III, CIBEROBN, Barcelona, Spain
Fuentes, F:
IMIBIC Hosp Reina Sofia, Lipid Unit, Cordoba, Spain
ISC III, CIBEROBN, Cordoba, Spain
Muniz, O:
Hosp Virgen Rocio, Dept Internal Med, Seville, Spain
Perez-Jimenez, F:
IMIBIC Hosp Reina Sofia, Lipid Unit, Cordoba, Spain
ISC III, CIBEROBN, Cordoba, Spain
Lopez-Miranda, J:
IMIBIC Hosp Reina Sofia, Lipid Unit, Cordoba, Spain
ISC III, CIBEROBN, Cordoba, Spain
Diaz, JL:
Hosp Abente & Lago, Dept Internal Med, La Coruna, Spain
Vidal, JI:
Hosp Lugo, Dept Endocrinol, Lugo, Spain
Barba, A:
Hosp Gen Albacete, Dept Internal Med, Albacete, Spain
Piedecausa, M:
Hosp Elche, Dept Internal Med, Elche, Spain
Sanchez, JF:
Hosp Caceres, Dept Internal Med, Caceres, Spain
Irigoyen, L:
Hosp Vitoria, Dept Endocrinol, Vitoria, Spain
Guallar, E:
Johns Hopkins Bloomberg, Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
Johns Hopkins Bloomberg, Sch Publ Hlth, Dept Med, Baltimore, MD USA
Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
Ordovas, JM:
Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
Tufts Univ, Nutrit & Genom Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA
Mata, P:
IIS Fdn Jimenez Diaz, Dept Internal Med, Madrid, Spain
Gold, Green Published
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