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Risk of brain infarction in familial hypercholesterolemia
1Department of Neurology, University of Helsinki, Finland.
Insights
Subjects with heterozygous familial hypercholesterolemia face high risks of both coronary heart disease and cerebrovascular disorders. Treatment methods did not significantly alter the occurrence of new cerebrovascular events during the study.
Area of Science:
- Cardiology
- Neurology
- Genetics
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels.
- Individuals with FH have an elevated risk of premature cardiovascular disease.
- Cerebrovascular complications in FH are less understood but potentially significant.
Purpose of the Study:
- To evaluate the long-term incidence of cerebrovascular disorders in subjects with heterozygous familial hypercholesterolemia.
- To compare the effectiveness of surgical (partial ileal bypass) versus conservative treatment on cholesterol levels and cerebrovascular events.
- To assess the risk of brain infarction in FH patients compared to the general population.
Main Methods:
- A prospective study followed 54 subjects with heterozygous FH for an average of 10 years.
- Subjects were divided into two matched groups: surgical (partial ileal bypass) and conservative (diet and hypolipidemic drugs).
- Data collected included serum cholesterol levels, occurrence of symptomatic cerebrovascular disorders, and brain infarctions.
Main Results:
- Surgical treatment led to a 32% decrease in serum cholesterol, while conservative treatment resulted in a 10% decrease.
- 14 out of 54 subjects (26%) developed symptomatic cerebrovascular disorders.
- Six subjects (11%) suffered a brain infarction, with two-thirds occurring during follow-up. Treatment type did not impact new cerebrovascular events.
Conclusions:
- Symptomatic familial hypercholesterolemia patients exhibit a high risk of cerebrovascular disorders, similar to their risk for coronary heart disease.
- The incidence of brain infarction in this FH cohort was at least 20 times higher than in the general population.
- Current treatment strategies for FH may not sufficiently mitigate the risk of cerebrovascular events.
Abstract:
We followed 54 subjects with heterozygous familial hypercholesterolemia for an average of 10 (range 3-14) years. Half were treated surgically with partial ileal bypass and the other half (matched for age, sex, coronary heart disease, blood pressure, diabetes mellitus, smoking, obesity, and serum cholesterol concentration) were treated conservatively with diet and hypolipidemic drugs. The mean decrease in serum cholesterol concentration from the average value of 522 mg/dl on entry into the study was 32% in the surgically treated group and 10% in the conservatively treated group. One quarter of the subjects (14 of 54) had symptomatic cerebrovascular disorders and one tenth (six of 54) suffered a brain infarction at a mean age of 43 (range 30-57) years. Two thirds of the brain infarctions occurred during follow-up. The method of treatment of familial hypercholesterolemia did not affect the number of new cerebrovascular events. The incidence of brain infarction was 7.4/1000/yr. The risk of brain infarction in these subjects with familial hypercholesterolemia was at least 20 times higher than in the general population. We conclude that symptomatic subjects with familial hypercholesterolemia have not only a high risk of coronary heart disease but also a high risk of cerebrovascular disorders.