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Lipid-Lowering Treatment in Familial Hypercholesterolaemia, 1996-2021: A Nationwide Study
Jacob Reeh1,2, Anders Berg Wulff1,2, Børge G Nordestgaard1,2
1Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 73, 2730, Herlev, Denmark.
Background:
In familial hypercholesterolaemia, early and intensive lipid-lowering treatment postpones coronary heart disease and death, effectively shown after introduction of statins and later ezetimibe and PCSK9 inhibitors. However, whether use of lipid-lowering treatment has improved in females and males with familial hypercholesterolaemia over time remains somewhat unclear. In this nationwide study, we tested the hypothesis that lipid-lowering treatment in familial hypercholesterolaemia improved from 1996 through 2021.
Methods:
In a nationwide study of 7,976,375 individuals aged 0-113 in Denmark, all with a diagnosis of familial hypercholesterolaemia from 1996 to 2021 were included. Temporal trends in lipid-lowering medication were described by sex and coronary heart disease.
Findings:
For females and males with familial hypercholesterolaemia, treatment with lipid-lowering medications increased from 1996 to about 2008 after which little change was seen. In females, any medical treatment increased from 76% (99/130) in 1996 to 86% (879/1027) in 2021 in those with coronary heart disease and from 52% (115/222) to 78% (2716/3462) in those without. Corresponding values for males were 67% (134/199)-90% (1006/1117) and 48% (105/219)-80% (1421/1772). In females with coronary heart disease, use of lipid-lowering combination therapy increased from 16% (21/130) in 1996 to 34% (345/1027) in 2021, high-intensity statin from 0% (0/88) to 41% (331/809), and lipid-lowering therapy initiation within one year of diagnosis from 45% (5/11) to 92% (343/374). Corresponding values for males were from 18% (35/199) to 50% (553/1117), from 0.8% (1/121) to 60% (570/946), and from 77% (23/30) to 92% (275/299). Similar trends were seen for individuals without coronary heart disease, however, with lower percentages.
Interpretation:
Nationwide in Denmark from 1996 through 2021, lipid-lowering medication use improved in those with familial hypercholesterolaemia irrespective of sex and coronary heart disease status.
Funding:
The Johan and Lise Boserup Foundation; The Independent Research Fund Denmark; and Copenhagen University Hospital-Herlev Gentofte, Denmark.
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