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LDL cholesterol burden in elderly patients with familial hypercholesterolemia: Insights from real-world data

Torunn Melnes1, Martin P Bogsrud2,3, Jacob J Christensen1

  • 1Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.

American Journal of Preventive Cardiology
|April 18, 2025
PubMed

Insights

Familial hypercholesterolemia (FH) patients with coronary heart disease (CHD) had a higher LDL-C burden, especially before treatment. This highlights the critical need for early detection and intervention in FH to prevent cardiovascular events.

Area of Science:

  • Cardiology
  • Genetics
  • Metabolic Disorders

Background:

  • Familial hypercholesterolemia (FH) is a genetic disorder causing high LDL-C and premature coronary heart disease (CHD).
  • Cumulative LDL-C exposure (LDL-C burden) may be a better cardiovascular risk predictor than current LDL-C levels in FH.
  • Real-world data is crucial for understanding LDL-C burden in elderly FH patients.

Purpose of the Study:

  • To estimate LDL-C burden at various ages in elderly FH patients with and without CHD.
  • To assess the LDL-C burden at the time of CHD onset in FH patients.
  • To compare LDL-C burden between FH patients with and without CHD.

Main Methods:

  • Retrospective data collection from elderly FH patients (>60 years) at a Lipid Clinic.
  • Calculation of LDL-C burden (mM-years) using repeated LDL-C measurements and medication data.
  • Estimation of time-weighted average (TWA) LDL-C by dividing LDL-C burden by duration.

Main Results:

  • FH patients with CHD had a significantly higher LDL-C burden at ages 45, 50, and 60 compared to those without CHD.
  • Higher TWA LDL-C was observed before treatment initiation in the CHD group, but not during follow-up.
  • No significant sex differences in LDL-C burden were found, though women had higher TWA LDL-C during follow-up.

Conclusions:

  • Elderly FH patients with CHD exhibit a higher LDL-C burden, primarily due to elevated levels before treatment.
  • These findings underscore the importance of early diagnosis and aggressive lipid-lowering therapy in FH to mitigate cardiovascular risk.
  • The study emphasizes LDL-C burden as a key metric for assessing long-term cardiovascular risk in FH.
Abstract

Keywords:
Cholesterol burdenCoronary heart diseaseCumulative LDL-C exposureElderlyFamilial hypercholesterolemia

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