Attainment of LDL-Cholesterol Treatment Goals in Patients With Familial Hypercholesterolemia 5-Year SAFEHEART Registry Follow-Up
Por:
de Isla, LP, Alonso, R, Watts, GF, Mata, N, Cerezo, AS, Muniz, O, Fuentes, F, Diaz-Diaz, JL, de Andres, R, Zambon, D, Rubio-Marin, P, Barba-Romero, MA, Saenz, P, Munoz-Torrero, JFS, Martinez-Faedo, C, Miramontes-Gonzalez, JP, Badimon, L, Mata, P
Publicada:
22 mar 2016
Resumen:
BACKGROUND Familial hypercholesterolemia (FH) is the most common genetic disorder associated with premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data on attainment of treatment targets; large registries that reflect real-life clinical practice can uniquely provide this information.
OBJECTIVES We sought to evaluate the achievement of low-density lipoprotein cholesterol (LDL-C) treatment goals in FH patients enrolled in a large national registry.
METHODS The SAFEHEART study (Spanish Familial Hypercholesterolemia Cohort Study) is a large, ongoing registry of molecularly defined patients with heterozygous FH treated in Spain. The attainment of guideline-recommended plasma LDL-C goals at entry and follow-up was investigated in relation to use of lipid-lowering therapy (LLT).
RESULTS The study recruited 4,132 individuals (3,745 of whom were >= 18 years of age); 2,752 of those enrolled were molecularly diagnosed FH cases. Mean follow-up was 5.1 +/- 3.1 years; 71.8% of FH cases were on maximal LLT, and an LDL-C treatment target <100 mg/dl was reached by only 11.2% of patients. At follow-up, there was a significant increase in the use of ezetimibe, drug combinations with statins, and maximal LLT. The presence of type 2 diabetes mellitus, a defective allele mutation, ezetimibe use, and the absence of previous ASCVD were predictors of the attainment of LDL-C goals.
CONCLUSIONS Despite the use of intensified LLT, many FH patients continue to experience high plasma LDL-C levels and, consequently, do not achieve recommended treatment targets. Type of LDL-receptor mutation, use of ezetimibe, coexistent diabetes, and ASCVD status can bear significantly on the likelihood of attaining LDL-C treatment goals. (C) 2016 by the American College of Cardiology Foundation.
Filiaciones:
de Isla, LP:
Hosp Clin San Carlos, IDISSC, Dept Cardiol, Madrid, Spain
Fdn Hipercolesterolemia Familiar, C Gen Alvarez Castro 14, Madrid 28010, Spain
Alonso, R:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez Castro 14, Madrid 28010, Spain
Clin Las Condes, Santiago, Chile
Watts, GF:
Royal Perth Hosp, Ctr Cardiovasc Med, Lipid Disorders Clin, Perth, WA 6001, Australia
Univ Western Australia, Sch Med & Pharmacol, Perth, WA 6009, Australia
Mata, N:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez Castro 14, Madrid 28010, Spain
Madrid Hlth Author, Dept Epidemiol, Madrid, Spain
Cerezo, AS:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez Castro 14, Madrid 28010, Spain
Hosp Tajo, Dept Cardiol, Madrid, Spain
Muniz, O:
Hosp Virgen Rocio, Dept Internal Med, Seville, Spain
Fuentes, F:
Univ Hosp, Dept Internal Med, Cordoba, Spain
Diaz-Diaz, JL:
Hosp Abente & Lago, Dept Internal Med, La Coruna, Spain
de Andres, R:
Fdn Jimenez Diaz, Dept Internal Med, E-28040 Madrid, Spain
Zambon, D:
Hosp Clin Barcelona, Dept Endocrinol, Barcelona, Spain
Rubio-Marin, P:
Hosp SAS Jerez Frontera, Dept Internal Med, Cadiz, Spain
Barba-Romero, MA:
Complejo Hosp Univ, Dept Internal Med, Albacete, Spain
Saenz, P:
Hosp Merida, Dept Internal Med, Extremadura, Spain
Munoz-Torrero, JFS:
Hosp San Pedro Alcantara, Dept Internal Med, Caceres, Spain
Martinez-Faedo, C:
Cent Hosp, Dept Endocrinol, Asturias, Spain
Miramontes-Gonzalez, JP:
Univ Hosp, Dept Internal Med, Salamanca, Spain
Badimon, L:
IIB St Pau, Inst Catalan Ciencias Cardiovasc, Barcelona, Spain
Mata, P:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez Castro 14, Madrid 28010, Spain
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