title: Improvement in LDL-cholesterol levels of patients with familial hypercholesterolemia: can we do better? Analysis of results obtained during the past two decades in 1669 French subjects.
abstract: BACKGROUND
  Heterozygous Familial Hypercholesterolemia (heFH) is an autosomal disease that affects about 1/500 people. It is characterized by markedly elevated plasma LDL-cholesterol (C) levels and an increased risk of cardiovascular disease (CVD). The aim of this study was to measure changes in LDL-C levels in heFH patients over two decades, and to evaluate if patients achieved LDL-C targets.
  
  
  METHODS
  Data from 1669 heFH patients in five academic French centers were recorded between 1988 and 2011.
  
  
  RESULTS
  The mean LDL-C concentrations under medical care improved between 1988 and 2011 (245 mg/dL before 1995, 164 mg/dL after 2009; p < 0.0001). However, mean LDL-C level and the number of patients treated with statins (79.3%) have not improved since 2005. In patients registered and treated after 2005 (n = 616), only 10.4% reached target LDL-C levels of <100 mg/dL. Indeed, 29.4% (n = 181) were treated with a maximal therapy (statins with a potency of >45% LDL-C reduction plus at least another lipid-lowering agent). Despite maximal treatment, only 18.8% of these heFH patients (n = 34/181) reached target LDL-C levels of <100 mg/dL. In addition, 75.3% of patients with CVD did not reach the LDL-C of <100 mg/dL.
  
  
  CONCLUSIONS
  This study demonstrates that after significant improvement over the past two decades, the mean LDL-C levels in heFH French patients has remained stable since 2005. We also show that most heFH patients are not achieving their recommended LDL-C goals: this highlights the need for improved treatment and for new therapeutics in this population.
authors.affiliation: Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism And Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Paris 75013, France. Electronic address: sophie.beliard@psl.aphp.fr.
authors.forename: S
authors.initials: S
authors.lastname: Béliard
authors.affiliation: Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism And Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Paris 75013, France.
authors.forename: V
authors.initials: V
authors.lastname: Carreau
authors.affiliation: Department of Biochemistry, La Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Carrié
authors.affiliation: Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism And Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Paris 75013, France.
authors.forename: P
authors.initials: P
authors.lastname: Giral
authors.affiliation: Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism And Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Paris 75013, France.
authors.forename: E
authors.initials: E
authors.lastname: Duchêne
authors.affiliation: Point Médical, Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Farnier
authors.affiliation: Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: Department of Diabetology-Endocrinolgy, Pasteur University Hospital, Nice, France.
authors.forename: A
authors.initials: A
authors.lastname: Fredenrich
authors.affiliation: INSERM UMR 1087/CNRS UMR 6291, CNRH Nantes, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Krempf
authors.affiliation: Department of Internal Medicine, University Hospital, Faculty of Pharmacy, Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Luc
authors.affiliation: Department of Endocrinology, Louis Pradel Cardiovascular Hospital, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Moulin
authors.affiliation: Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism And Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Paris 75013, France.
authors.forename: E
authors.initials: E
authors.lastname: Bruckert
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006938:Hyperlipoproteinemia Type II / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Familial hypercholesterolemia; LDL-cholesterol; Lipid-lowering therapy; Statins