Masana Luís, Zamora Alberto, Plana Núria, Comas-Cufí Marc, Garcia-Gil Maria, Martí-Lluch Ruth, Ponjoan Anna, Alves-Cabratosa Lia, Elosua Roberto, Marrugat Jaume, Dégano Irene R, Ramos Rafel
Lipids and Arteriosclerosis Research Unit, Sant Joan University Hospital, 43204 Reus, Catalonia, Spain.
Internal Medicine Department, IISPV, Universitat Rovira I Virgili, CIBERDEM, 43002 Reus, Catalonia, Spain.
J Clin Med. 2019 Jul 23;8(7):1080. doi: 10.3390/jcm8071080.
In the statin era, the incidence of atherosclerotic cardiovascular diseases (ASCVD) in patients with familial hypercholesterolemia (FH) has not been updated. We aimed to determine the incidence of ASCVD in patients with FH-phenotype (FH-P) and to compare it with that of normal low-density lipoprotein cholesterol (LDL-C) patients. We performed a retrospective cohort study using the Database of the Catalan primary care system, including ≥18-year-old patients with an LDL-C measurement. From 1,589,264 patients available before 2009, 12,823 fulfilled FH-P criteria and 514,176 patients were normolipidemic (LDL-C < 115 mg/dL). In primary prevention, patients with FH-P had incidences of ASCVD and coronary heart disease (CHD) of 14.9/1000 and 5.8/1000 person-years, respectively, compared to 7.1/1000 and 2.1/1000 person-years in the normolipidemic group. FH-P showed hazard ratio (HR) of 7.1 and 16.7 for ASCVD and CHD, respectively, in patients younger than 35 years. In secondary prevention, patients with FH-P had incidences of ASCVD and CHD of 89.7/1000 and 34.5/1000 person-years, respectively, compared to 90.9/1000 and 28.2/1000 person-years in the normolipidemic group (HR in patients younger than 35 years: 2.4 and 6.0). In the statin era, FH-P remains associated with high cardiovascular risk, compared with the normolipidemic population. This excess of risk is markedly high in young individuals.
在他汀类药物时代，家族性高胆固醇血症（FH）患者的动脉粥样硬化性心血管疾病（ASCVD）发病率尚未更新。我们旨在确定FH表型（FH-P）患者的ASCVD发病率，并将其与正常低密度脂蛋白胆固醇（LDL-C）患者的发病率进行比较。我们使用加泰罗尼亚初级保健系统数据库进行了一项回顾性队列研究，纳入了年龄≥18岁且有LDL-C测量值的患者。在2009年之前可获取的1,589,264例患者中，12,823例符合FH-P标准，514,176例患者血脂正常（LDL-C<115mg/dL）。在一级预防中，FH-P患者的ASCVD和冠心病（CHD）发病率分别为14.9/1000人年和5.8/1000人年，而血脂正常组分别为7.1/1000人年和2.1/1000人年。在35岁以下的患者中，FH-P的ASCVD和CHD风险比（HR）分别为7.1和16.7。在二级预防中，FH-P患者的ASCVD和CHD发病率分别为89.7/1000人年和34.5/1000人年，而血脂正常组分别为90.9/1000人年和28.2/1000人年（35岁以下患者的HR：2.4和6.0）。在他汀类药物时代，与血脂正常人群相比，FH-P仍然与高心血管风险相关。这种额外的风险在年轻人中明显更高。
