Clinical management of heterozygous familial hypercholesterolemia in a Polish outpatient metabolic clinic: a retrospective observational study

Abstract

IntroductionThere are currently no reports available from a Polish clinical practice on heterozygous familial hypercholesterolemia (HeFH) management. The aim of this study was to test the efficacy of HeFH hypolipidemic treatment in a Polish outpatient metabolic clinic according to treatment targets outlined in the European Atherosclerosis Society (EAS) and European Society of Cardiology (ESC) guidelines.Material and methodsThis retrospective, observational study was performed on HeFH patients who attended their routine follow-up visits in the metabolic outpatient clinic in the period between April and September 2016. According to EAS/ESC guidelines, the goal and intensity of therapy were assigned individually for every patient based on cardiovascular (CV) risk (high or very high). The treatment target was achievement of low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/l for very high CV risk patients and < 2.6 mmol/l for high CV risk patients. A ≥ 50% decrease in LDL-C over the observation period was an additional outcome measure.ResultsIn the overall group of 222 HeFH patients (mean age: 55.2 ±16.2 years, 72% women), LDL-C levels decreased on average by 52.6% (p < 0.001). More than half of the patients were treated with the maximum tolerated dose of statins. A total of 25.2% of patients attained target levels of LDL-C and 55.9% attained a ≥ 50% reduction in its concentration. Despite therapy, significantly elevated post-follow-up levels of LDL-C (> 4.1 mmol/l) remained in 14% of all patients.ConclusionsHypolipidemic therapy according to EAS/ESC guidelines was suboptimal for a significant number of HeFH patients. Additional clinical management should be considered.

Safety of ezetimibe in lipid-lowering treatment: systematic review and meta-analysis of randomised controlled trials and cohort studies

“…Of 3625 citations of observational studies, we included four cohort retrospective cohorts with 1667 participants in our narrative summary (figure 2, table 2, and online supplemental table S10). [31][32][33][34] Follow-up durations ranged from 72 to 400 weeks (that is, 1.38-7.70 years; median 282 weeks (that is, 5.42 years)). The population from two studies were identified from electronic health records.…”

Low-density lipoprotein cholesterol goal achievement in patients with familial hypercholesterolemia in countries outside Western Europe: The International ChoLesterol management Practice Study

“…Another study in Dutch patients with genetically or clinically diagnosed heterozygous FH (n 5 1249; 96% on statins) observed that 21% of patients reached a goal of ,2.6 mmol/L, and 46% of those with LDL-C .2.6 mmol/L achieved a .50% reduction in LDL-C. 7 Recently, a study of 222 patients from Poland with definite or probable FH (according to DLCN criteria) reported that 25.2% of patients achieved an LDL-C goal of ,1.8 mmol/ L or ,2.6 mmol/L, for those at very high or high CV risk, respectively, and 55.9% of patients achieved an LDL-C reduction of at least 50%. 13 Only 43.1% of patients with definite or probable FH had genetically confirmed FH. It was not possible to distinguish whether patients without genetic confirmation were not tested, or were tested but no mutation was identified.…”