Early treatment with statin reduces CV morbidity in Familial hypercholesterolemia, finds study

Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by elevated serum low-density lipoprotein cholesterol (LDL-C) from birth onwards, and is at increased risk for premature atherosclerosis and early cardiovascular events. Subclinical atherosclerosis can be quantified non- invasively by measuring the intima-media thickness (IMT), the thickness of inner most two layers of vessel wall. IMT is usually measured in the carotid and/or femoral artery and has been proven to be a surrogate marker of the status and progression of atherosclerosis. Statins are the preferred pharmacological therapy in patients with FH to reduce serum LDL-C levels, cardiovascular disease (CVD) morbidity and mortality.

Kika van Bergen et al, conducted a systematic literature search using MEDLINE, EMBASE and ClinicalTrials.gov up to April 2020 for studies addressing IMT in FH patients and controls to look at progression of IMT in FH patients as compared to controls and also the response to treatment. A total of 42 studies having 6,143 participants were included.

Important observations from this study are as follows:

1) FH patients had a mean IMT difference of 0.11 mm in carotids as compared to unaffected controls.

2) FH patients had a mean IMT difference of 0.47 mm in femoral artery as compared to unaffected controls.

3) In age category of 1 – 20 years, a mean carotid IMT difference was 0.07mm between FH patients and controls whereas it is 0.16 mm in age category of 41 – 60 years

4) A smaller mean difference in carotid IMT in treated FH patients vs controls: 0.05 mm (p < 0.001), than in untreated FH patients vs controls 0.12mm (p = 0.009) was observed

Authors concluded that Familial hypercholesterolemia patients have a higher mean carotid and femoral IMT compared to unaffected controls and starting treatment early in patients with FH is preferred as progression of IMT thickness is slower in treated patients than untreated. However, despite treatment, IMT in treated FH patients is still thicker in comparison to subjects without FH.

Keywords: Familial hypercholesterolemia, CV mortality, statins, Intima medial thickness, LDL

Source: Journal of Clinical Lipidology, 10.1016/j.jacl.2022.01.009