Familial hypercholesterolaemia (FH) is associated with reduced thymic output and accelerated thymic ageing, while statin treatment may help preserve immune cell production. In a Chinese study of 562 patients with heterozygous FH and 295 age-matched healthy controls, researchers found that untreated FH patients had a significantly lower proportion of recent thymic emigrants (RTEs) among naïve CD4+ T cells, particularly those aged 18–30 years and those carrying highly pathogenic LDLR variants. Additional analyses of T-cell receptor excision circles confirmed reduced thymic output in both naïve CD4+ and CD8+ T cells. FH patients also exhibited signs of accelerated thymic ageing, reaching the median CD4+ RTE level of healthy controls approximately six years earlier in both males and females. Consistent with reduced thymic output, their T-cell receptor repertoires showed greater clonal skewing toward high-frequency clones. Statin-treated patients, particularly females, had higher circulating CD4+ RTE levels than untreated patients. These findings suggest that lifelong hypercholesterolaemia may affect immune function beyond its established cardiovascular consequences and support further investigation of integrated metabolic and immunologic approaches to FH management. Source: https://academic.oup.com/eurheartj/
