Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China.
Lipids Health Dis. 2019 Jun 1;18(1):131. doi: 10.1186/s12944-019-1074-8.
Familial hypercholesterolemia (FH) is an important cause of premature coronary artery disease (CAD). Prognosis data are lacking in patients with FH and coronary artery disease particularly in the era of widespread statin use. We compared long-term prognosis between patients with and without FH after a coronary event.
In this retrospective study, 865 patients younger than 40 years of age with CAD were enrolled. FH was diagnosed based on the Dutch Lipid Clinic Network algorithm. Baseline characteristics, coronary angiographic findings and prognosis during median follow-up of 5 (3-8) years were compared between patients with or without FH.
Definite or probable FH was detected in 37 patients (4.3%) and possible FH in 259 patients (29.9%). FH was associated with significantly higher prevalence of multi-vessel lesions (p < 0.001) and higher Gensini score (p = 0.008). In the subset of 706 patients for whom follow-up data were available, 127 (18.0%) suffered major adverse cardiovascular and cerebrovascular events (MACCE). FH was associated with increased risk of MACCE, independently of age, sex, smoking, body mass index, hypertension or diabetes mellitus (HR = 2.30, 95%CI = 1.09 to 4.84, p = 0.028).
FH is an independent risk factor for MACCE in young patients after a coronary event during long-term follow-up. It is necessary to optimize lipid treatment of patients with FH after a coronary event.
家族性高胆固醇血症（FH）是导致早发冠状动脉疾病（CAD）的一个重要原因。FH 合并 CAD 患者的预后数据，尤其是在他汀类药物广泛应用的时代，仍然缺乏。本研究旨在比较发生冠状动脉事件后 FH 患者与非 FH 患者的长期预后。
本回顾性研究共纳入了 865 例年龄＜40 岁的 CAD 患者。FH 基于荷兰脂质临床网络算法进行诊断。比较 FH 患者与非 FH 患者的基线特征、冠状动脉造影结果以及中位 5 年（3-8 年）随访期间的预后。
37 例（4.3%）患者确诊为 FH，259 例（29.9%）患者可能为 FH。FH 患者多支血管病变的发生率显著更高（p＜0.001），Gensini 评分也更高（p=0.008）。在 706 例可获得随访数据的患者中，127 例（18.0%）发生了主要不良心脑血管事件（MACCE）。FH 是 MACCE 的独立危险因素，与年龄、性别、吸烟、体重指数、高血压或糖尿病无关（HR=2.30，95%CI=1.09 至 4.84，p=0.028）。
在长期随访中，FH 是发生冠状动脉事件后年轻患者 MACCE 的独立危险因素。FH 合并 CAD 患者发生冠状动脉事件后，有必要优化其降脂治疗。
