Department of Bioscience, National Cardiovascular Center Research Institute, Fujishirodai, Suita, Osaka, Japan.
J Atheroscler Thromb. 2010 Jul 30;17(7):667-74. doi: 10.5551/jat.4143. Epub 2010 Jun 4.
Familial hypercholesterolemia (FH) patients are at particular risk for premature coronary artery disease (CAD) caused by high levels of low density lipoprotein (LDL). Administration of statins enabled us to reduce LDL-C levels in heterozygous FH patients. To evaluate the impact of statins on the clinical fate of heterozygous FH, a retrospective study was performed.
We analyzed the clinical influence of statins on age at the first clinical onset of CAD in 329 consecutive FH patients referred to the lipid clinic of the National Cardiovascular Center. Among 329 heterozygous FH patients, the onset of CAD was identified in 101.
The age at onset of CAD was 58.8+/-12.5 years in the 25 patients on statins at onset, significantly higher than that in the 76 patients not on statins (47.6+/-10.5 years) (p <0.001). The average age at CAD onset was significantly higher after widespread use of statins (54.2+/-13.2 years in 48 patients, Group 1) compared to before October 1989 when statins were approved in Japan (46.9+/-9.6 years in 53 patients; Group 2, p=0.002). A significant difference was seen between Groups 1 and 2 in the variables, including sex, prevalence of smoking habit, LDL-C, and the use of statins, aspirin and probucol. After adjusting for these variables, only statin use was independently associated with the difference in age at CAD onset by multivariable analysis.
Statins have improved the clinical course of patients with heterozygous FH.
家族性高胆固醇血症（FH）患者由于低密度脂蛋白（LDL）水平升高，患早发性冠心病（CAD）的风险特别高。他汀类药物的应用使我们能够降低杂合子 FH 患者的 LDL-C 水平。为了评估他汀类药物对杂合子 FH 临床结局的影响，进行了一项回顾性研究。
我们分析了他汀类药物对 329 例连续 FH 患者首次发生 CAD 时年龄的临床影响，这些患者被转诊至国家心血管中心的血脂诊所。在 329 例杂合子 FH 患者中，101 例患者发生了 CAD。
在他汀类药物开始时即开始使用他汀类药物的 25 例患者中，CAD 的发病年龄为 58.8+/-12.5 岁，明显高于未使用他汀类药物的 76 例患者（47.6+/-10.5 岁）（p<0.001）。在广泛使用他汀类药物后，CAD 的平均发病年龄明显较高（48 例患者中为 54.2+/-13.2 岁，第 1 组），与日本批准他汀类药物前的 1989 年 10 月相比（53 例患者中为 46.9+/-9.6 岁；第 2 组，p=0.002）。第 1 组和第 2 组之间在性别、吸烟习惯患病率、LDL-C 和他汀类药物、阿司匹林和普罗布考的使用等变量方面存在显著差异。在校正这些变量后，多变量分析显示只有他汀类药物的使用与 CAD 发病年龄的差异独立相关。
他汀类药物改善了杂合子 FH 患者的临床病程。
