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Peretti N, Vimont A, Mas E, Lemale J, Reynaud R, Tounian P, Poinsot P, Restier L, Paillard F, Pradignac A, Pucheu Y, Rabès JP, Bruckert E, Gallo A, Béliard S. Treatment of pediatric heterozygous familial hypercholesterolemia 7 years after the EAS recommendations: Real-world results from a large French cohort. Arch Pediatr 2024; 31:188-194. [PMID: 38538465 DOI: 10.1016/j.arcped.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Heterozygous familial hypercholesterolemia (HeFH) predisposes to premature cardiovascular diseases. Since 2015, the European Atherosclerosis Society has advocated initiation of statins at 8-10 years of age and a low-density lipoprotein cholesterol (LDL-C) target of <135 mg/dL. Longitudinal data from large databases on pharmacological management of pediatric HeFH are lacking. OBJECTIVE Here, we describe treatment patterns and LDL-C goal attainment in pediatric HeFH using longitudinal real-world data. METHODS This was a retrospective and prospective multicenter cohort study (2015-2021) of children with HeFH, diagnosed genetically or clinically, aged <18 years, and followed up in the National French Registry of FH (REFERCHOL). Data on the study population as well as treatment patterns and outcomes are summarized as mean±SD. RESULTS We analyzed the data of 674 HeFH children (age at last visit: 13.1 ± 3.6 years; 82.0 % ≥10 years; 52.5 % females) who were followed up for a mean of 2.8 ± 3.5 years. Initiation of lipid-lowering therapy was on average at 11.8 ± 3.0 years of age for a duration of 2.5 ± 2.8 years. At the last visit, among patients eligible for treatment (573), 36 % were not treated, 57.1 % received statins alone, 6.4 % statins with ezetimibe, and 0.2 % ezetimibe alone. LDL-C was 266±51 mg/dL before treatment and 147±54 mg/dL at the last visit (-44.7 %) in treated patients. Regarding statins, 3.3 %, 65.1 %, and 31.6 % of patients received high-, moderate-, and low-intensity statins, respectively. Overall, 59 % of children on statin therapy alone and 35.1 % on bitherapy did not achieve the LDL-C goal; fewer patients in the older age group did not reach the treatment goal. CONCLUSION Pediatric patients with FH followed up in specialist lipid clinics in France receive late treatment, undertreatment, or suboptimal treatment and half of them do not reach the therapeutic LDL-C goal. Finding a more efficient framework for linking scientific evidence to clinical practice is needed.
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Affiliation(s)
- Noel Peretti
- Hospices Civil de Lyon, Pediatric Hospital Femme Mere Enfant HFME, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Bron, France; Lyon University, Claude Bernard Lyon-1 University, Lyon Est Medical School, Place d'Arsonval, Lyon, France; INSERM, CarMeN laboratory, U1060, Oullins, France.
| | - Alexandre Vimont
- Real World Evidence, Department of Public Health Expertise, Paris, France
| | - Emmanuel Mas
- CHU of Toulouse, Children Hospital, Department of pediatrics, Unit of Gastroenterology, Hepatology, Nutrition, and Inborn Errors of Metabolism, Toulouse, France; Toulouse University, Institute of Research in Digestive Science IRSD, INSERM, U-1220, Team 6, Toulouse, France
| | - Julie Lemale
- Assistance publique - Hôpitaux de Paris AP-HP, Trousseau Hospital, Department of Pediatric Nutrition and Gastroenterology, Paris, France
| | - Rachel Reynaud
- Assistance publique - Hôpitaux de Marseille AP-HM, Timone Children's Hospital, Pediatric Multidisciplinary Unit, Marseille, France
| | - Patrick Tounian
- Assistance publique - Hôpitaux de Paris AP-HP, Trousseau Hospital, Department of Pediatric Nutrition and Gastroenterology, Paris, France; Sorbonne University, Paris, France
| | - Pierre Poinsot
- Hospices Civil de Lyon, Pediatric Hospital Femme Mere Enfant HFME, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Bron, France
| | - Liora Restier
- Hospices Civil de Lyon, Pediatric Hospital Femme Mere Enfant HFME, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Bron, France
| | - François Paillard
- CHU of Rennes, Rennes University, Center of Cardiovascular-Prevention, Department of Cardiology, Rennes, France
| | - Alain Pradignac
- CHU of Strasbourg, University Hospital of Hautepierre, Department of Internal Medicine, Endocrinology and Nutrition, Strasbourg, France
| | - Yann Pucheu
- CHU de Bordeaux, Service des Maladies Coronaires et Vasculaires, Pessac, France
| | - Jean-Pierre Rabès
- Laboratory for Vascular Translational Science (LVTS), INSERM U1148, Centre Hospitalo-Universitaire Xavier Bichat, Paris, France; Laboratory of Biochemistry and Molecular Genetics, Centre Hospitalo-Universitaire Ambroise Paré, AP-HP. Paris-Saclay, Boulogne-Billancourt, France; UFR Simone Veil-Santé, UVSQ, Montigny-Le-Bretonneux, France
| | - Eric Bruckert
- Assistance Publique, Hôpitaux de Paris AP-HP, Pitié Salpetrière Hospital, Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, Paris, France; Assistance publique - Hôpitaux de Marseille APHM, La Conception Hospital, Nutrition, Metabolic Diseases and Endocrinology Department, Marseille, France
| | - Antonio Gallo
- Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, F-75013, Paris, France; Sorbonne Université, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Sophie Béliard
- Assistance publique - Hôpitaux de Marseille APHM, La Conception Hospital, Nutrition, Metabolic Diseases and Endocrinology Department, Marseille, France; INSERM, INRAE, Aix Marseille University, Department C2VN, Marseille, France
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Casula M, Gazzotti M, Capra ME, Olmastroni E, Galimberti F, Catapano AL, Pederiva C. Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study. Atherosclerosis 2023; 385:117231. [PMID: 37648636 DOI: 10.1016/j.atherosclerosis.2023.117231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age. METHODS From the Italian LIPIGEN cohort, we selected 1188 (≥18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation. RESULTS The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives. CONCLUSIONS In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy.
| | - Marta Gazzotti
- Fondazione SISA (Società Italiana per lo Studio dell'Aterosclerosi), 20133, Milano, Italy
| | - Maria Elena Capra
- Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121, Piacenza, Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy
| | | | | | - Cristina Pederiva
- Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142, Milan, Italy
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Schefelker JM, Peterson AL. Screening and Management of Dyslipidemia in Children and Adolescents. J Clin Med 2022; 11:6479. [PMID: 36362707 PMCID: PMC9656613 DOI: 10.3390/jcm11216479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 07/30/2023] Open
Abstract
This review provides an overview of pediatric dyslipidemia emphasizing screening and treatment recommendations. The presence of risk factors for cardiovascular disease in childhood poses significant risk for the development of atherosclerotic cardiovascular disease and cardiovascular events in adulthood. While atherogenic dyslipidemia is the most common dyslipidemia seen in children and can be suspected based on the presence of risk factors (such as obesity), familial hypercholesterolemia can be found in children with no risk factors. As such, universal cholesterol screening is recommended to identify children with these disorders in order to initiate treatment and reduce the risk of future cardiovascular disease. Treatment of pediatric dyslipidemia begins with lifestyle modifications, but primary genetic dyslipidemias may require medications such as statins. As pediatric lipid disorders often have genetic or familial components, it is important that all physicians are aware that cardiovascular risk begins in childhood, and can both identify these disorders in pediatric patients and counsel their adult patients with dyslipidemia to have their children screened.
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Affiliation(s)
| | - Amy L. Peterson
- Department of Pediatrics, Division of Pediatric Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA
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Antoniazi L, Arroyo-Olivares R, Mata P, Santos RD. Association of dietary patterns and components with atherosclerosis risk biomarkers in familial hypercholesterolemia. Curr Opin Lipidol 2022; 33:89-94. [PMID: 34907966 DOI: 10.1097/mol.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia (FH) is a relatively common genetic disorder associated with elevated atherosclerotic risk. Dietary interventions can modulate processes associated with cardiovascular risk and potentiate the impact of pharmacological lipid-lowering therapies. This review evaluates recent findings of dietary patterns and their components on risk biomarkers in people with FH. RECENT FINDINGS Diets lower in saturated fatty acids (SFA) may reduce low-density lipoprotein-cholesterol (LDL-C); however, their effects seem to be modest. A Mediterranean style diet apparently exerts more robust effects on plasma LDL-C, apolipoprotein B and C reactive protein concentrations than one restricted in SFA. Supplementation of plant sterols and stanols reduces LDL-C especially in children with FH. Caloric restricted diets may reduce weight and improve triglyceride levels in individuals with FH and excess body weight. SUMMARY Despite the strong impact of genetic variants, dietary patterns mostly low in SFA and especially the Mediterranean diet may influence risk biomarkers in FH. However, most available studies are limited by cross-sectional design, small number of study subjects and short-term follow-ups. Robust interventional studies are necessary to test the impact of dietary patterns in people with FH.
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Affiliation(s)
- Luiza Antoniazi
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | | | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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