Cross-Over Trial of Intensive Monotherapy With Atorvastatin and Combined Therapy With Atorvastatin and Colestimide for Japanese Familial Hypercholesterolemia

Treatment Patterns and Lipid Profile in Patients with Familial Hypercholesterolemia in Japan

Aim: To evaluate the epidemiology and real-world treatment patterns associated with lipid-modifying therapies (LMTs) among groups of Japanese patients with familial hypercholesterolemia (FH).

Methods: A retrospective observational study was conducted using an electronic hospital-based administrative claims database and electronic medical records. Patients with existing diagnosis of FH (FH-D) and patients with suspected FH (FH-S) defined by low-density lipoprotein cholesterol (LDL-C) ≥ 190 mg/dL were included, and medical records of hospitals across Japan were analyzed to assess the diagnostic status, management of LDL-C levels, and treatment patterns.

Results: Among the 3,495 patients who met the inclusion criteria, 193 patients were FH-D and 3,339 patients were FH-S. Among them, 83.5% had not achieved the LDL-C of < 100 mg/dL recommended for patients with FH at the index date. Mean LDL-C levels for all patients and for FH-D and FH-S patients were 145.8 mg/dL, 119.2 mg/dL, and 147.6 mg/dL, respectively. 44.5% of the patients were not currently treated with LMTs. High-intensity statins were used only in 19.2% and 2.3% of the FH-D and FH-S patients, respectively. Furthermore, among the FH-D and FH-S statin-treated patients, 61 (69.3%) and 1,059 (89.7%) remained on monotherapy even when their LDL-C was ≥ 100 mg/dL.

Conclusions: Treatment and management of LDL-C in Japanese FH patients remain suboptimal. The results suggest that FH is underdiagnosed in real-world, routine clinical practice in Japan. There is an urgent need to improve the diagnostic rate of FH and to provide the appropriate therapy to achieve the recommended LDL-C levels of < 100 mg/dL or a more than 50% reduction for patients with FH in Japan.

[Advances in cholesterol-lowering interventions]

Numerous epidemiological and prospective studies have shown a direct relationship between total cholesterol and low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (cardiovascular morbidity and mortality). In many intervention studies with more than 100,000 subjects, statins have shown a powerful and significant reduction of cardiovascular events and a decrease in cardiovascular and overall mortality, far superior to those produced by any other lipid-lowering group. Consequently statins are considered to be safe and well tolerated and are the first choice in the treatment of hypercholesterolemia and in cardiovascular disease prevention. If targets are not reached, other pharmacological groups must be associated (resins, nicotinic acid, ezetimibe, fibrates, etc.). Moreover, when hypercholesterolemia is associated with low concentrations of high-density lipoprotein (HDL)-cholesterol and high triglyceride levels, the association of statins with nicotinic acid, fibrates or omega-3 should be considered. Some questions remain to be answered: what LDL-C levels are desirable in secondary prevention? Which individuals might benefit from treatment in primary prevention? Which lipid-lowering drug is the most suitable to combine with statins and diminish cardiovascular risk in each situation? The present article reviews these important points.

Investigation of blood lipid levels and statin interventions in outpatients with coronary heart disease in China: the China Cholesterol Education Program (CCEP)

BACKGROUND

The aim of the China Cholesterol Education Program is to investigate the blood lipid levels, the statin intervention and the rates of achieving the goal of low-density lipoprotein-cholesterol (LDL-C) level in Chinese outpatients with coronary heart disease (CHD).

METHODS AND RESULTS

The multicenter study recruited 4,778 outpatients with CHD. The mean level of LDL-C for the total outpatients was 2.93+/-1.00 mmol/L; 82.2% of the participants received statin therapy. The LDL-C levels were 3.06+/-1.08 mmol/L and 2.89+/-0.97 mmol/L in outpatients with high risk and very high risk, respectively (p<0.001). No significant difference was found about the rates of statin intervention in outpatients at high risk and very high risk (81.4% vs 82.5%, p>0.05). Though they had higher rates of statin intervention, only 36.2% of the high-risk outpatients achieved the target LDL-C level (<2.6 mmol/L); 10.9% of the very high risk outpatients achieved the optimal LDL-C level (<1.82 mmol/L) suggested by NCEP ATP III. The rate of achieving the target level was only 42.2%, even though LDL-C <2.6mmol/L was the goal for patients at very high risk.

CONCLUSIONS

Although the outpatients received a higher rate of statin therapy, the rates of achieving the target cholesterol level were lower. There is a significant gap between the guidelines and clinical practice in China.

Apolipoprotein E polymorphism influences lipid phenotypes in Chinese families with familial combined hyperlipidemia

BACKGROUND

Apolipoprotein E (apoE) polymorphism is associated with changes in the lipoprotein profile of individuals with familial combined hyperlipidemia (FCHL), but its effects on the lipoprotein profiles of members of Chinese families with FCHL remain uncertain.

METHODS AND RESULTS

43 FCHL families (n=449) and 9 normolipidemic families (n=73) were recruited to assess the influence of apoE polymorphism on plasma lipids. The relative frequency of the epsilon4 allele in affected and unaffected FCHL relatives, spouses and normolipidemic members was 13.8%, 5.3%, 9.1% and 6.8%, respectively, with a significantly higher frequency in affected FCHL relatives, compared with unaffected FCHL relatives or normolipidemic members (p=0.0002 or p=0.029). In FCHL relatives, the apoE4 subset (E4/4 and E4/3) exhibited significantly higher levels of apoB, total cholesterol and low-density lipoprotein-cholesterol (LDL-C) than did the apoE3 (E3/3) subset, especially in women (all p<0.05), and there was significant elevation of LDL-C concentrations in men only (p<0.05). In men, the apoE2 (E3/2) subset indicated a decreased level of apoB and increased apoA1 compared with those in the apoE3 subset (p<0.05).

CONCLUSIONS

ApoE polymorphism appears to be associated with variance of the lipoprotein phenotype in Chinese families with FCHL.