TY - JOUR
T1 - Efficacy of statins in familial hypercholesterolaemia
T2 - A long term cohort study
AU - Versmissen, Jorie
AU - Oosterveer, Daniëlla M.
AU - Yazdanpanah, Mojgan
AU - Defesche, Joep C.
AU - Basart, Dick C.G.
AU - Liem, Anho H.
AU - Heeringa, Jan
AU - Witteman, Jacqueline C.
AU - Lansberg, Peter J.
AU - Kastelein, John J.P.
AU - Sijbrands, Eric J.G.
PY - 2008/11/11
Y1 - 2008/11/11
N2 - Objective: To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design: Cohort study with a mean follow-up of 8.5 years. Setting: 27 outpatient lipid clinics. Subjects: 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures: Risk of coronary heart disease in treated and "untreated" (delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results: In January 1990, 413 (21%) of the patients had started statin treatment, and during follow-up another 1294 patients (66%) started after a mean delay of 4.3 years. Most patients received simvastatin (n=1167, 33 mg daily) or atorvastatin (n=211, 49 mg daily). We observed an overall risk reduction of 76% (hazard ratio 0.24 (95% confidence interval 0.18 to 0.30), P<0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age-matched sample from the general population (hazard ration 1.44 (0.80 to 2.60), P=0.23). Conclusion: Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population.
AB - Objective: To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design: Cohort study with a mean follow-up of 8.5 years. Setting: 27 outpatient lipid clinics. Subjects: 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures: Risk of coronary heart disease in treated and "untreated" (delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results: In January 1990, 413 (21%) of the patients had started statin treatment, and during follow-up another 1294 patients (66%) started after a mean delay of 4.3 years. Most patients received simvastatin (n=1167, 33 mg daily) or atorvastatin (n=211, 49 mg daily). We observed an overall risk reduction of 76% (hazard ratio 0.24 (95% confidence interval 0.18 to 0.30), P<0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age-matched sample from the general population (hazard ration 1.44 (0.80 to 2.60), P=0.23). Conclusion: Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population.
UR - http://www.scopus.com/inward/record.url?scp=61849134974&partnerID=8YFLogxK
U2 - 10.1136/bmj.a2423
DO - 10.1136/bmj.a2423
M3 - Article
SN - 0959-8146
VL - 337
SP - 223
EP - 226
JO - BMJ (Online)
JF - BMJ (Online)
IS - 7688
ER -