LDL cholesterol burden in elderly patients with familial hypercholesterolemia: Insights from real-world data

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-03-29 DOI:10.1016/j.ajpc.2025.100986

Torunn Melnes , Martin P. Bogsrud , Jacob J. Christensen , Amanda Rundblad , Kjetil Retterstøl , Ingunn Narverud , Pål Aukrust , Bente Halvorsen , Stine M. Ulven , Kirsten B. Holven

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Abstract

Background and aims

Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) and increased risk of premature coronary heart disease (CHD). While current LDL-C levels usually guides therapy, the cumulative exposure to LDL-C (the LDL-C burden) is suggested to offer a more precise estimate of cardiovascular risk in people with FH. Therefore, using real-world data, this study aimed to estimate the LDL-C burden at different ages in elderly FH patients with and without CHD, and to assess the LDL-C burden at CHD onset.

Methods

Data was retrospectively collected from the medical records of elderly (>60 years) FH patients at the Lipid Clinic in Oslo. The LDL-C burden (mM-years) was estimated based on repeated LDL-C measurements and information on lipid-lowering medication. Time-weighted average (TWA) LDL-C was calculated as LDL-C burden divided by years.

Results

We included 112 FH patients, of which 55 (49 %) had experienced at least one CHD-event, and 58 (52 %) were females. Median age at first and last visit were 50 years and 68 years, respectively, with a median of 9 (range; 2–14) available LDL-C measurements. Subjects with CHD had higher LDL-C burden at all ages tested (45, 50 and 60 years) compared with the non-CHD group (p < 0.01, also after adjusting for sex), and had higher TWA LDL-C before treatment at the Lipid Clinic (p = 0.004), but not during follow-up (p = 0.6). There were no sex differences in LDL-C burden at all ages tested, also after adjusting for CHD (p > 0.1). However, women had higher TWA LDL-C during follow-up at the Lipid Clinic (p = 0.01). Median LDL-C burden at CHD onset was 352 mM-years; numerically lower in women than in men (320 vs. 357 mM-years, respectively. p = 0.1).

Conclusion

Elderly FH patients with CHD had higher estimated LDL-C burden compared with FH patients without CHD, due to higher burden prior to treatment, highlighting the importance of early

detection and treatment.

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家族性高胆固醇血症老年患者的LDL胆固醇负担：来自现实世界数据的见解

背景和目的家族性高胆固醇血症（FH）是一种以低密度脂蛋白胆固醇（LDL-C）升高和过早冠心病（CHD）风险增加为特征的遗传性疾病。虽然目前的LDL-C水平通常指导治疗，但建议累积暴露于LDL-C （LDL-C负担）可以更准确地估计FH患者的心血管风险。因此，本研究旨在利用真实世界的数据，评估合并和不合并冠心病的老年FH患者不同年龄的LDL-C负担，并评估冠心病发病时的LDL-C负担。方法回顾性收集奥斯陆脂质诊所老年（60岁）FH患者的病历资料。LDL-C负荷（mm -年）是根据重复LDL-C测量和降脂药物信息估计的。时间加权平均（TWA） LDL-C计算为LDL-C负担除以年数。结果纳入112例FH患者，其中55例（49%）至少经历过一次冠心病事件，58例（52%）为女性。首次和最后一次就诊的中位年龄分别为50岁和68岁，中位年龄为9岁(范围；2-14)可用的LDL-C测量。与非冠心病组相比，冠心病患者在所有年龄段（45岁、50岁和60岁）的LDL-C负担均较高(p <；在脂质诊所治疗前TWA LDL-C较高（p = 0.004），但在随访期间没有升高（p = 0.6）。在所有测试年龄，LDL-C负担没有性别差异，在调整冠心病后也是如此(p >；0.1)。然而，在脂质诊所随访期间，女性的TWA LDL-C较高（p = 0.01）。冠心病发病时LDL-C负荷中位数为352 mm -年；在数字上，女性低于男性（分别为320 mm -年和357 mm -年）。P = 0.1)。结论老年伴有冠心病的FH患者LDL-C估计负担高于无冠心病的FH患者，这是由于FH患者治疗前的负担较高，突出了早期发现和治疗的重要性。

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