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Published on: September 15, 2018
Prognostic impact of familial hypercholesterolemia on long-term outcomes in patients undergoing percutaneous coronary
Maximilian Tscharre1, Robert Herman2, Miklos Rohla1
13rd Medical Department with Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria; Institute of Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria.
Insights
Patients with probable or definite familial hypercholesterolemia (FH) have a doubled risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). This risk persists despite high-intensity statin use, highlighting the need for advanced therapies.
Area of Science:
- Cardiology
- Genetics
- Pharmacology
Background:
- Familial hypercholesterolemia (FH) significantly elevates the risk of premature cardiovascular disease.
- Long-term data on major adverse cardiovascular events (MACE) in FH patients post-percutaneous coronary intervention (PCI), especially with high-intensity statins, are limited.
Purpose of the Study:
- To evaluate the long-term prognostic impact of clinically diagnosed FH on MACE.
- To assess MACE risk in patients with stable coronary artery disease (SCAD) or acute coronary syndromes (ACS) undergoing PCI.
Main Methods:
- FH diagnosis utilized the Dutch Lipid Clinic Network criteria, categorizing patients into "unlikely FH" (0-2 points), "possible FH" (3-5 points), and "probable/definite FH" (≥6 points).
- A cohort of 1550 patients undergoing PCI was analyzed, with follow-up averaging 6.0 ± 2.4 years.
Main Results:
- Out of 1550 patients, 5.0% had probable/definite FH, 21.4% had possible FH, and 73.6% had unlikely FH.
- After adjusting for confounders, probable/definite FH patients faced a significant, approximately 2-fold increased risk of MACE (HR 1.922; P = .004) compared to unlikely FH patients.
- Patients with possible FH did not show a significantly increased risk of MACE (HR 1.105; P = .470).
Conclusions:
- Patients with probable or definite FH exhibit a nearly doubled risk of long-term MACE post-PCI, even with contemporary high-intensity statin therapy.
- Novel treatments like PCSK9 inhibitors, alongside current lipid-lowering strategies, may offer improved outcomes for FH patients.
Background:
Patients with familial hypercholesterolemia (FH) are at increased risk for premature and subsequent cardiovascular disease. Data on long-term major adverse cardiovascular events (MACE) in patients with FH after percutaneous coronary intervention (PCI) in the era of high-intensity statins are scarce.
Objective:
We assessed the prognostic impact of clinically diagnosed FH on long-term MACE, a composite of all-cause death, myocardial infarction, and ischemic stroke in patients admitted for stable coronary artery disease (SCAD) or acute coronary syndromes (ACSs) undergoing PCI.
Methods:
FH was diagnosed according to the Dutch Lipid Clinic Network diagnosis criteria: "Unlikely FH" diagnosis was defined as 0 to 2 points, "possible FH" as 3 to 5 points, and "probable/definite FH" diagnosis as 6 or higher.
Results:
From a total of 1550 eligible patients (47.4% were admitted for SCAD and 52.6% for ACS), 77 (5.0%) were classified as probable/definite FH, 332 (21.4%) as possible FH, and 1141 (73.6%) as unlikely FH. Mean follow-up was 6.0 ± 2.4 years. After adjustment for possible confounders, patients classified with probable or definite FH (hazard ratio [HR] 1.922 [95% confidence interval (CI) 1.220-2.999]; P = .004), but not patients with possible FH (HR 1.105 [95% CI 0.843-1.447]; P = .470) faced a significant, approximately 2-fold increased risk of MACE compared with patients with unlikely FH.
Conclusion:
After adjustment for confounders, patients with probable or definite FH faced an approximate 2-fold increased risk for long-term MACE compared with patients without FH despite the widespread use of high-intensity statins. The new option of proprotein convertase subtilisin/kexin type 9 gene inhibitors in addition to other current optimal lipid-lowering strategies might help to further improve clinical outcome in patients with probable/definite FH.
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