Long-term effect of 2 intensive statin regimens on treatment and incidence of cardiovascular events in familial hypercholesterolemia: The SAFEHEART study

Abstract

BACKGROUND: Maximal doses of potent statins are the basement of treatment of familial hypercholesterolemia (FH). Little is known about the use of different statin regimens in FH. OBJECTIVES: The objectives of the study were to describe the treatment changes and low-density lipoprotein cholesterol (LDL-C) goal achievement with atorvastatin (ATV) and rosuvastatin (RV) in the SAFEHEART cohort, as well as to analyze the incidence of atherosclerotic cardiovascular events (ACVEs) and changes in the cardiovascular risk. METHODS: SAFEHEART is a prospective follow-up nationwide cohort study in a molecularly defined FH population. The patients were contacted on a yearly basis to obtain relevant changes in life habits, medication, and ACVEs. RESULTS: A total of 1939 patients were analyzed. Median follow-up was 6.6 years (5-10). The estimated 10-year risk according the SAFEHEART risk equation was 1.61 (0.67-3.39) and 1.22 (0.54-2.93) at enrollment for ATV and RV, respectively (P , .001). There were no significant differences at the follow-up: 1.29 (0.54-2.82) and 1.22 (0.54-2.76) in the ATV and RV groups, respectively (P 5 .51). Sixteen percent of patients in primary prevention with ATV and 18% with RV achieved an LDL-C ,100 mg/dL and 4% in secondary prevention with ATV and 5% with RV achieved an LDL-C ,70 mg/dL. The use of ezetimibe was marginally greater in the RV group. One hundred sixty ACVEs occurred during follow-up, being its incidence rate 1.1 events/100 patient-years in the ATV group and 1.2 in the RV group (P 5 .58). CONCLUSION: ATV and RV are 2 high-potency statins widely used in FH. Although the reduction in LDL-C levels was greater with RV than with ATV, the superiority of RV for reducing ACVEs was not demonstrated.

Comparative Effects Between High-intensity Atorvastatin and Rosuvastatin on New Onset Diabetes Mellitus and Cardiovascular Outcome

“…In patients with acute coronary syndrome, both the atorvastatin and rosuvastatin groups had comparable effects on lipid parameters [15,16], although patients with familial hypercholesterolemia in the rosuvastatin group demonstrated a greater reduction in LDL cholesterol levels than those in the atorvastatin group [17]. Some studies has reported more favorable effects of rosuvastatin on reducing atherosclerotic plaque volume [15,18] and plaque stabilization [15] than atorvastatin, however, there has been no signi cant difference with regard to the cardiovascular outcome in both groups [17,19].…”

New Onset Diabetes Mellitus and Cardiovascular Events in Korean Patients with Acute Myocardial Infarction Receiving High-Intensity Statins

“…In patients with acute coronary syndrome, both the atorvastatin and rosuvastatin groups had comparable effects on lipid parameters, [15,16] although patients with familial hypercholesterolemia in the rosuvastatin group demonstrated a greater reduction in LDL cholesterol levels than those in the atorvastatin group. [17] Some studies have reported more favorable effects of rosuvastatin on reducing atherosclerotic plaque volume [15,18] and plaque stabilization [15] than of atorvastatin; however, there has been no signi cant difference with regard to the cardiovascular outcome in both groups. [17,19] In line with these previous studies, we could not identify the differences between the effects of highintensity atorvastatin and rosuvastatin administration on major cardiovascular events.…”

“…[17] Some studies have reported more favorable effects of rosuvastatin on reducing atherosclerotic plaque volume [15,18] and plaque stabilization [15] than of atorvastatin; however, there has been no signi cant difference with regard to the cardiovascular outcome in both groups. [17,19] In line with these previous studies, we could not identify the differences between the effects of highintensity atorvastatin and rosuvastatin administration on major cardiovascular events. Several studies have suggested the possible mechanisms underlying the effect of statin on glucose metabolism.…”

<p>Barriers to Early Diagnosis and Treatment of Familial Hypercholesterolemia: Current Perspectives on Improving Patient Care</p>

“…A recent study showed that less than 5% of FH patients with ASCVD receiving LLT to reduce LDL-C levels at least 50% achieved an absolute LDL-C level below 70 mg/dL. 71 In this scenario, most of patients with FH could potentially require PCSK9i to achieve the targets. It has been shown that alirocumab and evolocumab are well tolerated and yield an additional 50% to 60% reduction in LDL-C levels in patients with FH under LLT.…”