The Younger to Treat Familial Hypercholesterolemia the Better

A 20-year follow-up study in the Netherland concluded that initiation of statin therapy during childhood in patients with familial hypercholesterolemia (FH) slowed the progression of carotid intima–media thickness and reduced the risk of cardiovascular disease in adulthood. Of the original cohort, 184 of 214 FH patients and 77 of 95 their unaffected siblings were seen in follow-up; among the 214 patients, data on cardiovascular events and on death from cardiovascular causes were available for 203 and 214, respectively. The mean LDL cholesterol level in the patients had decreased from 237.3 to 160.7 mg per deciliter (from 6.13 to 4.16 mmol per liter); treatment goals (LDL cholesterol <100 mg per deciliter [2.59 mmol per liter]) were achieved in 37 patients. Mean progression of carotid intima–media thickness over the entire follow-up period was 0.0056 and 0.0057 mm per year in patients with FH and in siblings, respectively. The cumulative incidence of cardiovascular events and of death from cardiovascular causes at 39 years of age was lower among the FH patients than among their affected parents for whom statins were available much later in life (1% vs. 26% and 0% vs. 7%, respectively). FH is a common autosomal dominant disorder of lipoprotein metabolism. The findings extend previous observational data on FH patients and make a strong case for not only “the lower the better” but also for “the younger the better.” Source: https://www.nejm.org/