Efficacy of statins in familial hypercholesterolaemia: a long term cohort study.
OBJECTIVE
To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia.


METHODS
Cohort study with a mean follow-up of 8.5 years.


METHODS
27 outpatient lipid clinics.


METHODS
2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990.


METHODS
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).


CONCLUSIONS
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.
Versmissen
Jorie
J
Department of Internal Medicine, Erasmus University Medical Centre, PO box 2040, 3000 CA Rotterdam, Netherlands.
Oosterveer
Daniëlla M
DM
Yazdanpanah
Mojgan
M
Defesche
Joep C
JC
Basart
Dick C G
DC
Liem
Anho H
AH
Heeringa
Jan
J
Witteman
Jacqueline C
JC
Lansberg
Peter J
PJ
Kastelein
John J P
JJ
Sijbrands
Eric J G
EJ
D000328:Adult; D000069059:Atorvastatin; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006938:Hyperlipoproteinemia Type II / Q000188:drug therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D011758:Pyrroles / Q000008:administration & dosage*; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage*; D016896:Treatment Outcome
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin