Percutaneous Coronary Intervention in Familial Hypercholesterolemia Is Understudied

Abstract

Familial hypercholesterolemia (FH) is a common heritable condition in which mutations of genes governing cholesterol metabolism result in elevated LDL levels and accelerated atherosclerosis. The treatment of FH focuses on lipid lowering drugs to decrease patients' cholesterol levels and reduce their risk of cardiovascular events. Even with optimal medical therapy, some FH patients will develop coronary atherosclerosis, suffer myocardial infarction, and require revascularization. Yet, the revascularization of FH patients has not been widely studied. Here we review FH, identify unanswered questions in the interventional management of FH patients, and explore barriers and opportunities for answering these questions. Further research is needed in this neglected but important topic in interventional cardiology.

Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records

“…Over 84% of patients in the Simon Broome register had linked secondary care records from HES, which enabled comprehensive and robust ascertainment of different CVD outcomes, as well as interventions such as coronary interventions. We were also able to quantify the rates of coronary revascularisations in FH patients, which to date, has largely been understudied [ 13 ].…”

“…Over 84% of patients in the Simon Broome register had linked secondary care records from HES, which enabled comprehensive and robust ascertainment of different CVD outcomes, as well as interventions such as coronary interventions. We were also able to quantify the rates of coronary revascularisations in FH patients, which to date, has largely been understudied [13]. Study limitations include the lack of data on lipid-lowering treatments or more recent LDL-cholesterol concentrations beyond the time of SB registration, which could potentially explain the observed differences in CVD outcomes in men and women.…”

State-of-the-Art Pediatric Coronary Artery Bypass Surgery: a Literature Review

“…Despite the good results of endovascular revascularization in the adult patients with familial hypercholesterolemia, especially using bioabsorbable stents, most authors are unanimous in the unacceptability of this strategy in pediatric practice and the preference for CABG [ 34 , 35 ] . Literature review indicates the obligatory use of left or both internal thoracic arteries, while venous grafts should be used only in the presence of a multivascular lesion for complete myocardial revascularization.…”

Familial Hypercholesterolemia in the Arabian Gulf Region: Clinical results of the Gulf FH Registry

“…Individuals with FH are at high risk of atherosclerosis and its consequences. In those cases, FH manifests as premature coronary artery disease (CAD), and patients are at increased risk of peripheral artery disease and stroke, which increases morbidity and mortality [ 7 ]. Although the high CAD risk among patients with FH is well-established, the onset of cardiovascular events is variable; it depends on age, gender, and other risk factors, like hypertension, smoking, and high lipoprotein(a) levels.…”