Predicting Cardiovascular Events in Familial Hypercholesterolemia The SAFEHEART Registry (Spanish Familial Hypercholesterolemia Cohort Study)
Por:
de Isla, LP, Alonso, R, Mata, N, Fernandez-Perez, C, Muniz, O, Diaz-Diaz, JL, Saltijeral, A, Fuentes-Jimenez, F, de Andres, R, Zambon, D, Piedecausa, M, Cepeda, JM, Mauri, M, Galiana, J, Brea, A, Munoz-Torrero, JFS, Padro, T, Argueso, R, Miramontes-Gonzalez, JP, Badimon, L, Santos, RD, Watts, GF, Mata, P
Publicada:
30 may 2017
Resumen:
BACKGROUND: Although risk factors for atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolemia (FH) have been described, models for predicting incident ASCVD have not been reported. Our aim was to use the SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study) to define key risk factors for predicting incident ASCVD in patients with FH.
METHODS: SAFEHEART is a multicenter, nationwide, long-term prospective cohort study of a molecularly defined population with FH with or without previous ASCVD. Analyses to define risk factors and to build a risk prediction equation were developed, and the risk prediction equation was tested for its ability to discriminate patients who experience incident ASCVD from those who did not over time.
RESULTS: We recruited 2404 adult patients with FH who were followed up for a mean of 5.5 years (SD, 3.2 years), during which 12 (0.5%) and 122 (5.1%) suffered fatal and nonfatal incident ASCVD, respectively. Age, male sex, history of previous ASCVD, high blood pressure, increased body mass index, active smoking, and low-density lipoprotein cholesterol and lipoprotein(a) levels were independent predictors of incident ASCVD from which a risk equation with a Harrell C index of 0.85 was derived. The bootstrap resampling (100 randomized samples) of the original set for internal validation showed a degree of overoptimism of 0.003. Individual risk was estimated for each person without an established diagnosis of ASCVD before enrollment in the registry by use of the SAFEHEART risk equation, the modified Framingham risk equation, and the American College of Cardiology/American Heart Association ASCVD Pooled Cohort Risk Equations. The Harrell C index for these models was 0.81, 0.78, and 0.8, respectively, and differences between the SAFEHEART risk equation and the other 2 were significant (P= 0.023 and P= 0.045).
CONCLUSIONS: The risk of incident ASCVD may be estimated in patients with FH with simple clinical predictors. This finding may improve risk stratification and could be used to guide therapy in patients with FH.
Filiaciones:
de Isla, LP:
Fdn Hipercolesterolemia Familiar, Gen Alvarez de Castro 14, Madrid 28010, Spain
Univ Complutense, Cardiol Dept, Hosp Clin San Carlos, IDISSC, Madrid, Spain
Alonso, R:
Fdn Hipercolesterolemia Familiar, Gen Alvarez de Castro 14, Madrid 28010, Spain
Clin Las Condes, Santiago, Chile
Mata, N:
Fdn Hipercolesterolemia Familiar, Gen Alvarez de Castro 14, Madrid 28010, Spain
Madrid Hlth Author, Dept Epidemiol, Madrid, Spain
Fernandez-Perez, C:
Univ Complutense, Clin Epidemiol Unit, Serv Med Prevent, Inst Invest Sanitaria San Carlos, Madrid, Spain
Muniz, O:
Hosp Virgen Rocio, Dept Internal Med, Seville, Spain
Diaz-Diaz, JL:
Hosp Abente & Lago, Dept Internal Med, La Coruna, Spain
Saltijeral, A:
Fdn Hipercolesterolemia Familiar, Gen Alvarez de Castro 14, Madrid 28010, Spain
Univ Alfonso X el Sabio, Hosp Tajo, Cardiol Dept, Madrid, Spain
Fuentes-Jimenez, F:
Univ Cordoba, Lipids & Atherosclerosis Unit, Inst Maimonides Invest Biomed Cordoba, Reina Sofia Univ Hosp, Cordoba, Spain
de Andres, R:
Fdn Jimenez Diaz, IIS, Dept Internal Med, Madrid, Spain
Zambon, D:
Hosp Clin Barcelona, Dept Endocrinol, Barcelona, Spain
Piedecausa, M:
Hosp Univ Elche, Dept Internal Med, Alicante, Spain
Cepeda, JM:
Hosp Vega Baja, Dept Internal Med, Alicante, Spain
Mauri, M:
Hosp Terrassa, Dept Internal Med, Barcelona, Spain
Galiana, J:
Hosp Ciudad Real, Dept Internal Med, Ciudad Real, Spain
Brea, A:
Hosp San Pedro, Dept Internal Med, Logrono, Spain
Munoz-Torrero, JFS:
Hosp San Pedro Alcantara, Dept Internal Med, Caceres, Spain
Padro, T:
Inst Invest Biomed St Pau, Inst Catalan Ciencias Cardiovasc, Barcelona, Spain
Argueso, R:
Hosp Univ Lugo, Dept Endocrinol, Lugo, Spain
Miramontes-Gonzalez, JP:
Hosp Univ Salamanca, Dept Internal Med, Salamanca, Spain
Badimon, L:
Inst Invest Biomed St Pau, Inst Catalan Ciencias Cardiovasc, Barcelona, Spain
Santos, RD:
Univ Sao Paulo, Lipid Clin, Heart Inst InCor, Med Sch Hosp, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Prevent Ctr, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Cardiol Program, Sao Paulo, Brazil
Watts, GF:
Univ Western Australia, Lipid Disorders Clin, Dept Cardiol, Royal Perth Hosp,Sch Med & Pharmacol, Nedlands, WA, Australia
Mata, P:
Fdn Hipercolesterolemia Familiar, Gen Alvarez de Castro 14, Madrid 28010, Spain
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