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Laufs U, Birkenfeld AL, Fraass U, Hohenstein B, Siegert C, Klotsche J, Steinhagen-Thiessen E, Pittrow D, Dexl S, Salmen S, Schettler VJJ, Parhofer KG. Novel Insights into the Management of Patients with Very High Cardiovascular Risk Eligible for PCSK9 Inhibitor Treatment: Baseline Findings from the PERI-DYS Study. Cardiovasc Drugs Ther 2024; 38:119-129. [PMID: 36178485 PMCID: PMC10876819 DOI: 10.1007/s10557-022-07386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
AIM The PERI-DYS study aims to characterize two groups of patients with dyslipidaemia at very high CV risk: PCSK9i receivers and patients qualifying for but not receiving PCSK9i. METHODS This is an observational study by office-based and clinic-based physicians, mainly cardiologists and other internists in Germany, with data extracted from patient charts. CLINICALTRIALS gov identifier NCT03110432. RESULTS A total of 1659 patients were enrolled across 70 sites. The majority of patients (91.0%) were reported as having mixed dyslipidaemia or non-familial or heterozygous familial hypercholesterolemia. At enrolment, 794 (47.9%) of patients were PCSK9i receivers (of these 65.9% ongoing, and 34.1% newly treated within 30 days before their baseline visit). Among PCSK9i receivers, the majority had evolocumab 140 mg (n = 632, 38.1% of total). PCSK9i receivers compared to non-receivers were about 2 years younger and had a lower proportion of males. In terms of comorbidities, they had (statistically significantly) more often CAD, and less often PAD, diabetes mellitus, arterial hypertension and chronic renal disease. The calculated untreated median LDL-C was 187 mg/dl (IQR 127; 270) in ongoing PCSK9i receivers, 212 mg/dl (IQR 132; 277) in newly treated PCSK9i receivers, and 179 mg/dl (IQR 129; 257) in non-receivers. Physician-reported statin intolerance was much more common in the two PCSK9i receiver groups as compared to non-receivers (67.3% versus 15.3%). Consequently, patients in the PCSK9i groups received fewer concomitant statins. Mean total cholesterol (143 vs. 172 mg/dl) and LDL-C (69 vs. 99 mg/dl) were considerably lower in ongoing PCSK9i receivers compared to non-receivers. CONCLUSIONS PCSK9i receivers are characterized by higher baseline LDL-C and a higher portion of statin intolerance compared to those qualified for but not-receiving PCSK9i treatment. On-treatment, LDL-C was lower in PCSK9i receivers. Ongoing follow-up will determine the prognostic importance of these findings.
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Affiliation(s)
- Ulrich Laufs
- Klinik und Poliklinik Für Kardiologie, Universitätsklinikum, Leipzig, Germany.
| | - Andreas L Birkenfeld
- Innere Medizin IV - Diabetologie, Endokrinologie Und Nephrologie Am Universitätsklinikum, Tübingen, Germany
- Institut Für Diabetesforschung und Metabolische Erkankungen (IDM) des Helmholtz Zentrums München, Partner des Deutschen Zentrums Für Diabetesforschung (DZD E.V.), Munich, Germany
| | | | - Bernd Hohenstein
- Nephrologisches Zentrum Villingen-Schwenningen, Göttingen, Germany
| | | | | | | | - David Pittrow
- Medizinische Fakultät, Technische Universität, Dresden, Germany
- Innovationszentrum Real-World Evidence, GWT-TUD GmbH, Dresden, Germany
| | | | | | | | - Klaus G Parhofer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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Arca M, Celant S, Olimpieri PP, Colatrella A, Tomassini L, D'Erasmo L, Averna M, Zambon A, Catapano AL, Russo P. Real-World Effectiveness of PCSK9 Inhibitors in Reducing LDL-C in Patients With Familial Hypercholesterolemia in Italy: A Retrospective Cohort Study Based on the AIFA Monitoring Registries. J Am Heart Assoc 2023; 12:e026550. [PMID: 37850449 PMCID: PMC10727418 DOI: 10.1161/jaha.122.026550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/18/2023] [Indexed: 10/19/2023]
Abstract
Background Information on the real-world use of proprotein convertase subtilisin kexin 9 inhibitors (PCKS9is) in familial hypercholesterolemia are limited. We evaluated the pattern of prescription and the long-term efficacy of alirocumab and evolocumab in Italian patients with familial hypercholesterolemia in clinical practice. Methods and Results The data set for analysis was extracted from the PCKS9i Italian Medicines Agency (AIFA) registry and included 2484 patients with heterozygous familial hypercholesterolemia (HeFH) and 62 patients with homozygous familial hypercholesterolemia (HoFH) who were prescribed PCKS9is from February 2017 to December 2021. As the follow-up schedules were not prespecified and could vary, persistence and adherence as well as low-density lipoprotein cholesterol (LDL-C) changes during 2 years of treatment were analyzed in a final cohort of 1299 patients with familial hypercholesterolemia. At baseline, 53.8% of patients with HeFH and 69.4% of patients with HoFH were receiving maximally tolerated lipid-lowering therapies, while 45.9% of patients with HeFH and 30.7% of patients with HoFH reported statin intolerance; mean LDL-C was 197.7±52.3 mg/dL in HeFH and 252.0±106.2 mg/dL in HoFH. The 6-month persistence and adherence to therapy were >85%, and LDL-C reduction reached 58.6% (to 79.7 mg/dL) in HeFH and 57.6% (to 95.1 mg/dL) in HoFH after 24 months of treatment. The European Atherosclerosis Society/European Society of Cardiology LDL-C goals were achieved in 43.3% of patients with HeFH and 37.5% of patients with HoFH. Conclusions PCKS9i prescribed to patients with familial hypercholesterolemia in clinical practice showed LDL-C-lowering efficacy similar to that observed in controlled trials. However, 2 of 5 HeFH cases and 2 of 6 HoFH cases achieved the recommended LDL-C goals. The full achievement of European Atherosclerosis Society/European Society of Cardiology LDL-C goals should require a lower threshold for PCKS9i initiation and a combination of multiple therapies.
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Affiliation(s)
- Marcello Arca
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | | | | | | | | | - Laura D'Erasmo
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Maurizio Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE)University of PalermoPalermoItaly
| | | | - Alberico Luigi Catapano
- Department of Pharmacological and Biomolecular Sciences Rodolfo PaolettiUniversity of Milan and IRCCS MultimedicaMilanItaly
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Faubert S, Paquette M, Baass A, Bernard S. Treatment target achievement in patients with familial hypercholesterolemia: A real-world descriptive study. Clin Biochem 2023; 120:110649. [PMID: 37739254 DOI: 10.1016/j.clinbiochem.2023.110649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Statin and ezetimibe represent the first line of lipid-lowering therapy in patients with familial hypercholesterolemia (FH), a disease associated with a strong cardiovascular risk. The current low-density lipoprotein cholesterol (LDL-C) target achievement rate in a real-world context using these conventional treatments has never been investigated in the Province of Quebec (Canada). OBJECTIVE The primary objective of this study was to evaluate the proportion of FH patients in primary cardiovascular prevention who attained their recommended LDL-C threshold without being treated with a PCSK9 inhibitor. METHODS Patients included in this retrospective study were followed at the Lipid Clinic of the Montreal Clinical Research Institute. All patients were molecularly defined (97%) or had a definite clinical diagnosis of FH. RESULTS A total of 225 patients were included in this study, of which 73% were on high-intensity statin therapy. While two-thirds of the cohort achieved the LDL-C treatment target of ≥ 50% reduction from baseline, only one third attained the target of < 2.5 mmol/L (<97 mg/dL). However, patients on high-intensity statin therapy were two times more likely to achieve the < 2.5 mmol/L targets as compared to those treated with low or moderate statin intensity (p = 0.01). There was no significant difference in treatment target achievement between men and women. CONCLUSION Target achievement rate was unacceptably low in our FH patients. Conventional lipid-lowering treatments alone may not be sufficient in most FH patients to ensure adequate cardiovascular prevention.
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Affiliation(s)
- Simon Faubert
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada
| | - Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada; Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Québec, Canada
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec, Canada; Department of Medicine, Division of Endocrinology, Université de Montreal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, Québec, Canada.
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Sonmez A, Demirci I, Haymana C, Tasci I, Ayvalı MO, Ata N, Ezgu FS, Bayram F, Barcin C, Caglayan M, Ülgü MM, Birinci S, Tokgozoglu L, Satman I, Kayikcioglu M. Clinical characteristics of adult and paediatric patients with familial hypercholesterolemia: A real-life cross-sectional study from the Turkish National Database. Atherosclerosis 2023; 375:9-20. [PMID: 37216728 DOI: 10.1016/j.atherosclerosis.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is the most common cause of premature atherosclerotic cardiovascular disease (ASCVD). Türkiye is among the countries with the highest rate of ASCVD. However, no population-based study has been published so far on the prevalence of FH, demographic and clinical characteristics, burden of ASCVD, treatment compliance, and attainment of low-density lipoprotein cholesterol (LDL-C) targets. METHODS We performed a study using the Turkish Ministry of Health's national electronic health records involving 83,063,515 citizens as of December 2021 dating back 2016. Adults fulfilling the diagnostic criteria of definite or probable FH according to the Dutch Lipid Network Criteria (DLNC), and children and adolescents fulfilling the criteria of probable FH according to the European Atherosclerosis Society (EAS) Consensus Panel report formed the study population (n = 157,790). The primary endpoint was the prevalence of FH. RESULTS Probable or definite FH was detected in 0.63% (1 in 158) of the adults and 0.61% (1 in 164) of the total population. The proportion of adults with LDL-C levels >4.9 mmol/L (190 mg/dL) was 4.56% (1 in 22). The prevalence of FH among children and adolescents was 0.37% (1 in 270). Less than one-third of the children and adolescents, and two-thirds of young adults (aged 18-29) with FH were already diagnosed with dyslipidaemia. The proportion of adults and children and adolescents on lipid-lowering treatment (LLT) was 32.1% and 1.5%, respectively. The overall discontinuation rate of LLT was 65.8% among adults and 77.9% among children and adolescents. Almost no subjects on LLT were found to attain the target LDL-C levels. CONCLUSIONS This nationwide study showed a very high prevalence of FH in Türkiye. Patients with FH are diagnosed late and treated sub-optimally. Whether these findings may explain the high rates of premature ASCVD in Türkiye needs further investigation. These results denote the urgent need for country-wide initiatives for early diagnosis and effective management of FH patients.
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Affiliation(s)
- Alper Sonmez
- Ankara Guven Hospital, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Ibrahim Demirci
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Cem Haymana
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Ilker Tasci
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Internal Medicine, Ankara, Turkiye
| | - Mustafa Okan Ayvalı
- General Directorate of the Health Information Systems, Ministry of Health, Ankara, Turkiye
| | - Naim Ata
- Department of Strategy Development, Ministry of Health, Ankara, Turkiye
| | - Fatih Suheyl Ezgu
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkiye
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkiye
| | - Cem Barcin
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Cardiology, Ankara, Turkiye
| | - Murat Caglayan
- University of Health Sciences, Yildirim Beyazit Training and Research Hospital, Department of Biochemistry, Ankara, Turkiye
| | - Mustafa Mahir Ülgü
- General Directorate of the Health Information Systems, Ministry of Health, Ankara, Turkiye
| | - Suayip Birinci
- Deputy Health Minister, Ministry of Health, Ankara, Turkiye
| | - Lale Tokgozoglu
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkiye
| | - Ilhan Satman
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkiye
| | - Meral Kayikcioglu
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkiye.
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Sarkies M, Jones LK, Pang J, Sullivan D, Watts GF. How Can Implementation Science Improve the Care of Familial Hypercholesterolaemia? Curr Atheroscler Rep 2023; 25:133-143. [PMID: 36806760 PMCID: PMC10027803 DOI: 10.1007/s11883-023-01090-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Describe the application of implementation science to improve the detection and management of familial hypercholesterolaemia. RECENT FINDINGS Gaps between evidence and practice, such as underutilization of genetic testing, family cascade testing, failure to achieve LDL-cholesterol goals and low levels of knowledge and awareness, have been identified through clinical registry analyses and clinician surveys. Implementation science theories, models and frameworks have been applied to assess barriers and enablers in the literature specific to local contextual factors (e.g. stages of life). The effect of implementation strategies to overcome these factors has been evaluated; for example, automated identification of individuals with FH or training and education to improve statin adherence. Clinical registries were identified as a key infrastructure to monitor, evaluate and sustain improvements in care. The expansion in evidence supporting the care of familial hypercholesterolaemia requires a similar expansion of efforts to translate new knowledge into clinical practice.
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Affiliation(s)
- Mitchell Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Laney K Jones
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA, USA
- Heart and Vascular Institute, Geisinger, Danville, PA, USA
| | - Jing Pang
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
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Alonso R, Arroyo-Olivares R, Muñiz-Grijalvo O, Díaz-Díaz JL, Muñoz-Torrero JS, Romero MJ, de Andrés R, Zambón D, Mañas MD, Fuentes-Jiménez F, Aguado R, Alvarez-Baños P, Arrieta F, Gonzalez-Bustos P, Cepeda J, Martin-Ordiales M, Mosquera D, Michan A, de Isla LP, Argueso R, Mata P. Persistence with long-term PCSK9 inhibitor treatment and its effectiveness in familial hypercholesterolaemia: data from the SAFEHEART study. Eur J Prev Cardiol 2023; 30:320-328. [PMID: 36416136 DOI: 10.1093/eurjpc/zwac277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
AIMS Most heterozygous familial hypercholesterolaemia (FH) patients require intensive lipid-lowering therapy (LLT) including PCSK9 inhibitors (PCSK9is) to reach current low-density lipoprotein cholesterol (LDL-C) goals. Persistence with chronic treatment is important to reduce the burden of atherosclerotic cardiovascular disease. We analysed persistence, efficacy, and impact on quality of life (QoL) of PCSK9i in FH patients in clinical practice setting. METHODS AND RESULTS Spanish Familial Hypercholesterolaemia Cohort Study (SAFEHEART) is an open, prospective study in genetically defined FH patients in Spain. Patients ≥18 years of age (n = 696, 46% females) on stable LLT treated with PCSK9i were analysed. Median LDL-C at starting PCSK9i was 145 mg/dL [interquartile range (IQR), 123-177], 3.8 mmol/L (IQR 3.2-4.6). After a median follow up of 3.7 years (IQR 2.3-4.8), 27 patients (4%) discontinued PCSK9i treatment: 5 temporarily (0.7%) and 22 permanently (3.2%). Persistence with PCSK9i was 96.1% in the whole period. Median LDL-C levels and % LDL-C reduction attained after 1 year of treatment and in the last follow-up visit were 63 mg/dL (IQR 43-88), 1.6 mmol/L (IQR 1.1-2.23); 61 mg/dL (IQR 44-82), 1.6 mmol/L (IQR 1.1-2.1); 57.6% (IQR 39.5-69); and 58% (IQR 44-68), respectively. 2016 and 2019 ESC/EAS LDL-C goals were attained by 77 and 48% of patients, respectively, at the last follow-up visit (P < 0.001). Mean QoL score increased slightly in the first year and remained stable. CONCLUSION Long-term persistence with PCSK9i in FH patients is very high, with a good QoL. Effectiveness in LDL-C reduction and LDL-C goal achievement dramatically improved with PCSK9i in this high-risk population in clinical practice setting. TRIAL REGISTRATION ClinicalTrials.gov number NCT02693548.
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Affiliation(s)
- Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
- Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Fundación hipercolesterolemia Familiar, Madrid, Spain
| | - Raquel Arroyo-Olivares
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
| | | | | | | | - Manuel J Romero
- Department of Internal Medicine, Hospital Infanta Elena, Huelva, Spain
| | | | | | | | - Francisco Fuentes-Jiménez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofia University Hospital, CIBERObn, Córdoba, Spain
| | - Rocío Aguado
- Department of Endocrinology, Hospital General de León, León, Spain
| | - Pilar Alvarez-Baños
- Department of Endocrinology, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Pablo Gonzalez-Bustos
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José Cepeda
- Department of Internal Medicine, Hospital Comarcal Vega Baja, Orihuela, Spain
| | | | - Daniel Mosquera
- Department of Internal Medicine, Hospital San Pedro, Logroño, Spain
| | - Alfredo Michan
- Department of Internal Medicine, Hospital de Jerez, Jerez, Spain
| | | | - Rosa Argueso
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
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Prevalence of Diabetes and Its Association with Atherosclerotic Cardiovascular Disease Risk in Patients with Familial Hypercholesterolemia: An Analysis from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH). Pharmaceuticals (Basel) 2022; 16:ph16010044. [PMID: 36678541 PMCID: PMC9863379 DOI: 10.3390/ph16010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Familial hypercholesterolemia (FH) and type 2 diabetes mellitus (T2DM) are both associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Little is known about the prevalence of T2DM and its association with ASCVD risk in FH patients. This was a cross-sectional analysis from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH) including adults with FH (n = 1719, mean age 51.3 ± 14.6 years). Of FH patients, 7.2% had a diagnosis of T2DM. The prevalence of ASCVD, coronary artery disease (CAD), and stroke was higher among subjects with T2DM compared with those without (55.3% vs. 23.3%, 48.8% vs. 20.7%, 8.3% vs. 2.7%, respectively, p < 0.001). When adjusted for age, systolic blood pressure, smoking, body mass index, hypertension, waist circumference, triglyceride levels, high-density lipoprotein cholesterol levels, and gender, T2DM was significantly associated with prevalent ASCVD [OR 2.0 (95% CI 1.2−3.3), p = 0.004]. FH patients with T2DM were more likely to have undergone coronary revascularization than those without (14.2% vs. 4.5% for coronary artery bypass graft, and 23.9% vs. 11.5% for percutaneous coronary intervention, p < 0.001). T2DM is associated with an increased risk for prevalent ASCVD in subjects with FH. This may have implications for risk stratification and treatment intensity in these patients.
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8
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Rizos CV, Skoumas I, Rallidis L, Skalidis E, Tziomalos K, Garoufi A, Anagnostis P, Sfikas G, Kotsis V, Doumas M, Kolovou G, Lambadiari V, Dima I, Kiouri E, Zacharis E, Agapakis D, Attilakos A, Antza C, Vlachopoulos C, Liberopoulos EN. LDL cholesterol target achievement in heterozygous familial hypercholesterolemia patients according to 2019 ESC/EAS lipid guidelines: Implications for newer lipid-lowering treatments. Int J Cardiol 2021; 345:119-124. [PMID: 34687802 DOI: 10.1016/j.ijcard.2021.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The 2019 European guidelines (ESC/EAS) for the treatment of dyslipidaemias recommend more aggressive targets for low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia (FH). Current lipid-lowering treatment is often inadequate to achieve these targets. METHODS Data from the HELLAS-FH registry were analysed to assess achievement of LDL-C targets in adults with FH based on the 2019 ESC/EAS guidelines. In patients who had not achieved LDL-C target, the maximally reduced LDL-C value was calculated after theoretical switch to rosuvastatin/ezetimibe 40/10 mg/day. The percentage of patients who remained candidates for proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) was then calculated. RESULTS Patients (n = 1694, mean age 50.8 ± 14.7 years) had LDL-C levels 242 ± 71 mg/dL (6.3 ± 1.8 mmol/L) at diagnosis. Most treated patients were receiving statins (97.5%) and about half were on additional ezetimibe (47.5%). Based on the 2019 ESC/EAS guidelines the percentage of patients achieving LDL-C goals was only 2.7%. Following theoretical up titration to rosuvastatin/ezetimibe 40/10 mg, LDL-C target achievement rate would increase to 5.9%. In this scenario, most patients (55.9%) would be eligible for PCSK9i treatment. Following theoretical administration of a PCSK9i, LDL-C target achievement rate would rise to 57.6%. However, 42.4% of patients would still be eligible for further LDL-C lowering treatment. CONCLUSIONS Most FH patients do not reach new LDL-C targets even if on maximum intensity statin/ezetimibe treatment. In this case, more than half of FH patients are candidates for PCSK9i therapy and a considerable proportion may still require additional LDL-C lowering.
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Affiliation(s)
- Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Ioannis Skoumas
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece
| | - Loukianos Rallidis
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Emmanouil Skalidis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Tziomalos
- 1st Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Anastasia Garoufi
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Β' Pediatrics Clinic, General Children's Hospital "Pan. & Aglaia Kyriakou", Athens, Greece
| | | | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Vasileios Kotsis
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens, Greece
| | - Vaia Lambadiari
- 2nd Propaedeutic Internal Medicine Department and Diabetes Research Unit, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ioanna Dima
- Cardiology Clinic, Hippokration General Hospital, Athens, Greece
| | - Estela Kiouri
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Evangelos Zacharis
- Cardiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - Dimitrios Agapakis
- 1st Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece; Department of Internal Medicine, Goumenissa, Greece
| | - Achilleas Attilakos
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, C' Pediatrics Clinic, Attikon University General Hospital, Athens, Greece
| | - Christina Antza
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Lewek J, Konopka A, Starostecka E, Penson PE, Maciejewski M, Banach M. Clinical Features of Familial Hypercholesterolemia in Children and Adults in EAS-FHSC Regional Center for Rare Diseases in Poland. J Clin Med 2021; 10:4302. [PMID: 34640319 PMCID: PMC8509252 DOI: 10.3390/jcm10194302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetic autosomal co-dominant metabolic disorder leading to elevated circulating concentrations of low-density lipoprotein cholesterol (LDL-C). Early development of atherosclerotic cardiovascular disease (ASCVD) is common in affected patients. We aimed to evaluate the characteristics and differences in the diagnosis and therapy of FH children and adults. Methods: All consecutive patients who were diagnosed with FH, both phenotypically and with genetic tests, were included in this analysis. All patients are a part of the European Atherosclerosis Society FH-Study Collaboration (FHSC) regional center for rare diseases at the Polish Mother's Memorial Hospital Research Institute (PMMHRI) in Lodz, Poland. Results: Of 103 patients with FH, there were 16 children (15.5%) at mean age of 9 ± 3 years and 87 adults aged 41 ± 16; 59% were female. Children presented higher mean levels of total cholesterol, LDL-C, and high-density lipoprotein cholesterol (HDL-C) measured at the baseline visit (TC 313 vs. 259 mg/dL (8.0 vs. 6.6 mmol/L), p = 0.04; LDL 247 vs. 192 mg/dL (6.3 vs. 4.9 mmol/L), p = 0.02, HDL 53 vs. 48 mg/dL (1.3 vs. 1.2 mmol/L), p = 0.009). Overall, 70% of adult patients and 56% of children were prescribed statins (rosuvastatin or atorvastatin) on admission. Combination therapy (dual or triple) was administered for 24% of adult patients. Furthermore, 13.6% of adult patients and 19% of children reported side effects of statin therapy; most of them complained of muscle pain. Only 50% of adult patients on combination therapy achieved their treatment goals. None of children achieved the treatment goal. CONCLUSIONS Despite a younger age of FH diagnosis, children presented with higher mean levels of LDL-C than adults. There are still urgent unmet needs concerning effective lipid-lowering therapy in FH patients, especially the need for greater use of combination therapy, which may allow LDL-C targets to be met in most of the patients.
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Affiliation(s)
- Joanna Lewek
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland;
| | - Agnieszka Konopka
- Regional Rare Disease Centre, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland; (A.K.); (E.S.)
| | - Ewa Starostecka
- Regional Rare Disease Centre, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland; (A.K.); (E.S.)
| | - Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK;
- Liverpool Centre for Cardiovascular Science, Liverpool L7 8TX, UK
| | - Marek Maciejewski
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland;
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland;
- Cardiovascular Research Centre, University of Zielona Gora, 65-046 Zielona Gora, Poland
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Polychronopoulos G, Tzavelas M, Tziomalos K. Heterozygous familial hypercholesterolemia: prevalence and control rates. Expert Rev Endocrinol Metab 2021; 16:175-179. [PMID: 33993819 DOI: 10.1080/17446651.2021.1929175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Heterozygous familial hypercholesterolemia (heFH) is associated with a very high risk for cardiovascular events. Treatment with potent statins substantially reduces cardiovascular morbidity in these patients. Moreover, combination therapy with statins plus ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors facilitates achievement of low-density lipoprotein cholesterol (LDL-C) targets in patients with heFH. However, heFH remains underdiagnosed and undertreated worldwide.Areas covered: In this review, we summarize current evidence on the prevalence and control rates of heFH. Accumulating data suggest that heFH is one of the most common hereditary metabolic disorders, affecting approximately 1 in every 300 individuals. However, only a small minority of patients with heFH achieve LDL-C targets, even in high-income countries and in subjects followed-up in specialized lipid clinics.Expert opinion: Given the underdiagnosis of heFH using cascade and opportunistic screening, wider, population-based screening strategies should be evaluated for their feasibility and cost-effectiveness if we aspire to timely diagnosis and therefore prevention of cardiovascular morbidity and mortality in this very high risk population. Overcoming inertia in uptitrating statin dose, adding ezetimibe and/or PCSK9 inhibitors along with more generous reimbursement for lipid-lowering agents in patients with heFH are essential for improving goal attainment rates.
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Affiliation(s)
- Georgios Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marios Tzavelas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force. Atherosclerosis 2021; 325:99-109. [PMID: 33892925 DOI: 10.1016/j.atherosclerosis.2021.03.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in high-risk and very-high-risk patients. METHODS Evidence-based review. RESULTS Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro- and microvascular benefits in patients with type 2 diabetes mellitus. CONCLUSIONS This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.
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Boytsov S, Katapano A, Barbarash O, Yezhov M, Meshkov A, Voevoda M, Gurevich V, Kashtalap V, Duplyakov D, Vezikova N, Sadykova D. Actual issues of lipid centers’ operation in Russian Federation. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gazzotti M, Casula M, Olmastroni E, Averna M, Arca M, Catapano AL. How registers could enhance knowledge and characterization of genetic dyslipidaemias: The experience of the LIPIGEN in Italy and of other networks for familial hypercholesterolemia. ATHEROSCLEROSIS SUPP 2020; 42:e35-e40. [PMID: 33589222 DOI: 10.1016/j.atherosclerosissup.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism, still underdiagnosed and undertreated in the general population. Pathology registers could play a crucial role in the creation of a comprehensive and integrated global approach to cover all aspects of this disease. Systematic data collection of patients affected by FH has increased dramatically worldwide in the past few years. Moreover, results from registers already established for the longest time showed their potentialities in the implementation of the knowledge of FH, comparing country-specific approaches and providing real-world data about identification, management and treatment of FH individuals in the clinical practice. The potential fields of research through registers are related to the deepening of the genetic basis of disease, the study of genotype-phenotype correlation, the local adaption and implementation of diagnostic algorithms, the comparison of pharmacological approaches and treatment gaps in real-life clinical practice, the evaluation of specific subpopulations, and the identification of factors modifying cardiovascular disease risk. Registers could become also a valid resource for other rare dyslipidaemias, contributing towards the evidence-based enhancement in the worldwide care of uncommon diseases.
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Affiliation(s)
- Marta Gazzotti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Maurizio Averna
- Department ProMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), University of Palermo, Palermo, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
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D'Erasmo L, Commodari D, Di Costanzo A, Minicocci I, Polito L, Ceci F, Montali A, Maranghi M, Arca M. Evolving trend in the management of heterozygous familial hypercholesterolemia in Italy: A retrospective, single center, observational study. Nutr Metab Cardiovasc Dis 2020; 30:2027-2035. [PMID: 32830020 DOI: 10.1016/j.numecd.2020.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/12/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The effective reduction of LDL-C in patients with heterozygous familial hypercholesterolemia (HeFH) is crucial to reduce their increased cardiovascular risk. Diagnostic and therapeutic (PCSK9 inhibitors) tools to manage HeFH improved in recent years. However, the impact of these progresses in ameliorating the contemporary real-world care of these patients remains to be determined. Aim of this study was to assess the evolution of treatments and LDL-C control in a cohort of HeFH patients in Italy. METHODS AND RESULTS Four hundred six clinically diagnosed HeFH followed in a single, tertiary lipid centre were included in this survey. Data on lipid levels and medications were collected at baseline and during a median 3-year follow-up. At baseline, 19.8% of patients were receiving conventional high-potency lipid lowering therapies (LLT) and this percentage increased up to 50.8% at last visit. The knowledge of results of molecular diagnosis was associated with a significant increase in treatment intensity and LDL-C lowering. Nevertheless, the new LDL-C target (<70 mg/dl) was achieved only in 3.6% of HeFH patients under conventional LLTs and this proportion remained low (2.9%) also in those exposed to maximal conventional LLT. In 51 patients prescribed with PCSK9 inhibitors, 64.6% and 62.1% reached LDL-C<70 mg/dl at 3- and 12-month follow-up, respectively. CONCLUSIONS Although treatments of HeFH improved over time, LDL-C target achievement with conventional LLT remains poor, mainly among women. The use of molecular diagnosis and even more the prescription of PCSK9i may improve LDL-C control in these patients.
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Affiliation(s)
- Laura D'Erasmo
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy; Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Daniela Commodari
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Ilenia Minicocci
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Luca Polito
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Fabrizio Ceci
- Department of Experimental Medicine, Università degli Studi di Roma, Sapienza, Rome, Italy
| | - Anna Montali
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Università degli studi di Roma, Sapienza, Rome, Italy
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Vrablik M, Tichý L, Freiberger T, Blaha V, Satny M, Hubacek JA. Genetics of Familial Hypercholesterolemia: New Insights. Front Genet 2020; 11:574474. [PMID: 33133164 PMCID: PMC7575810 DOI: 10.3389/fgene.2020.574474] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Familial hypercholesterolemia (FH) is one of the most common monogenic diseases, leading to an increased risk of premature atherosclerosis and its cardiovascular complications due to its effect on plasma cholesterol levels. Variants of three genes (LDL-R, APOB and PCSK9) are the major causes of FH, but in some probands, the FH phenotype is associated with variants of other genes. Alternatively, the typical clinical picture of FH can result from the accumulation of common cholesterol-increasing alleles (polygenic FH). Although the Czech Republic is one of the most successful countries with respect to FH detection, approximately 80% of FH patients remain undiagnosed. The opportunities for international collaboration and experience sharing within international programs (e.g., EAS FHSC, ScreenPro FH, etc.) will improve the detection of FH patients in the future and enable even more accessible and accurate genetic diagnostics.
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Affiliation(s)
- Michal Vrablik
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Lukas Tichý
- Centre of Molecular Biology and Gene Therapy, University Hospital, Brno, Czechia
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Vladimir Blaha
- Internal Gerontometabolic Department, Charles University and University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Martin Satny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav A Hubacek
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia.,Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
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Korneva VA, Kuznetsova TY, Scopetc IS, Vezikova NN. [Experience of the use of the PCSK9 inhibitor Alirocumab in patients with extremely high cardiovascular risk]. KARDIOLOGIIA 2020; 60:71-77. [PMID: 33155961 DOI: 10.18087/cardio.2020.8.n1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.
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Mickiewicz A, Futema M, Ćwiklinska A, Kuchta A, Jankowski M, Kaszubowski M, Chmara M, Wasąg B, Fijałkowski M, Jaguszewski M, Humphries SE, Gruchała M. Higher Responsiveness to Rosuvastatin in Polygenic versus Monogenic Hypercholesterolaemia: A Propensity Score Analysis. Life (Basel) 2020; 10:E73. [PMID: 32443900 PMCID: PMC7281142 DOI: 10.3390/life10050073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The monogenic defect in familial hypercholesterolemia (FH) is detected in ∼40% of cases. The majority of mutation-negative patients have a polygenic cause of high LDL-cholesterol (LDL-C). We sought to investigate whether the underlying monogenic or polygenic defect is associated with the response to rosuvastatin. METHODS FH Individuals were tested for mutations in LDLR and APOB genes. A previously established LDL-C-specific polygenic risk score (PRS) was used to examine the possibility of polygenic hypercholesterolemia in mutation-negative patients. All of the patients received rosuvastatin and they were followed for 8 ± 2 months. A propensity score analysis was performed to evaluate the variables associated with the response to treatment. RESULTS Monogenic subjects had higher mean (±SD) baseline LDL-C when compared to polygenic (7.6 ± 1.5 mmol/L vs. 6.2 ± 1.2 mmol/L; p < 0.001). Adjusted model showed a lower percentage of change in LDL-C after rosuvastatin treatment in monogenic patients vs. polygenic subjects (45.9% vs. 55.4%, p < 0.001). The probability of achieving LDL-C targets in monogenic FH was lower than in polygenic subjects (0.075 vs. 0.245, p = 0.004). Polygenic patients were more likely to achieve LDL-C goals, as compared to those monogenic (OR 3.28; 95% CI: 1.23-8.72). CONCLUSION Our findings indicate an essentially higher responsiveness to rosuvastatin in FH patients with a polygenic cause, as compared to those carrying monogenic mutations.
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Affiliation(s)
- Agnieszka Mickiewicz
- Department of Cardiology I, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (M.F.); (M.J.); (M.G.)
| | - Marta Futema
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK;
| | - Agnieszka Ćwiklinska
- Department of Clinical Chemistry, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (A.Ć.); (A.K.); (M.J.)
| | - Agnieszka Kuchta
- Department of Clinical Chemistry, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (A.Ć.); (A.K.); (M.J.)
| | - Maciej Jankowski
- Department of Clinical Chemistry, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (A.Ć.); (A.K.); (M.J.)
| | - Mariusz Kaszubowski
- Institute of Statistics, Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, 80-233 Gdańsk, Poland;
| | - Magdalena Chmara
- Department of Biology and Genetics, Medical University of Gdansk, Dębinki 1, 80-211 Gdańsk, Poland; (M.C.); (B.W.)
| | - Bartosz Wasąg
- Department of Biology and Genetics, Medical University of Gdansk, Dębinki 1, 80-211 Gdańsk, Poland; (M.C.); (B.W.)
| | - Marcin Fijałkowski
- Department of Cardiology I, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (M.F.); (M.J.); (M.G.)
| | - Miłosz Jaguszewski
- Department of Cardiology I, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (M.F.); (M.J.); (M.G.)
| | - Steve E. Humphries
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, the Rayne Building University College London, London WC1E 6JF, UK;
| | - Marcin Gruchała
- Department of Cardiology I, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; (M.F.); (M.J.); (M.G.)
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