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High burden of recurrent cardiovascular events in heterozygous familial hypercholesterolemia: The French Familial Hypercholesterolemia Registry

Sophie Béliard 1, 2 Franck Boccara 3, 4 Bertrand Cariou 5 Alain Carrié 6, 7 Xavier Collet 8 Michel Farnier 9 Jean Ferrières 10 Michael Krempf 11 Noël Peretti 12 Jean Pierre Rabès 13 Rene Valero 14, 2 Alexandre Vimont Mathilde Varret 15 Sybil Charriere 16 Eric Bruckert 17 D. Angoulvant 18 S. Beliard P. Benlian C. Boileau V. Carreau Mathilde Di Filippo 12 P. Ducluzeau S. Dulong 19 V. Durlach 20 E. Ferrari A. Gallo P. Girardet R. Hankard 21 D. Lalau B. Lefort J. Lemale P. Moulin F. Paillard A. Pradignac Y. Pucheu S. Saheb A. Sultan 22, 23 P. Tounian R. Valéro 24 B. Vergès 25 C. Yelnik O. Ziegler
Abstract : Background and aims: Cardiovascular risk is high in heterozygous familial hypercholesterolemia (HeFH). The objective of this study was to describe recurrent cardiovascular events in selected patients with HeFH attending lipid clinics in France. Methods: We included 781 patients with a clinical (Dutch Lipid Clinic Network score >= 6) or genetic diagnosis of HeFH who had experienced a first cardiovascular event (myocardial infarction, percutaneous coronary intervention or coronary bypass, unstable angina, stroke, peripheral arterial revascularization or cardiovascular death) and were enrolled in the French Familial Hypercholesterolemia Registry (November 2015 to March 2018). Results: The first cardiovascular event occurred at the mean age of 47 years (interquartile range 39-55) in a predominantly male population (72%); 48% of patients were on statin therapy. Overall, 37% of patients had at least one recurrent cardiovascular event (mean of 1.8 events per patient), of which 32% occurred in the 12 months after the index event; 55% of events occurred > 3 years after the first event. Mean LDL-C at the last clinic visit was 144 +/- 75 mg/dL (132 +/- 69 mg/dL for patients on high-potency statin therapy and 223 +/- 85 mg/dL for untreated patients). Conclusions: The rate of recurrent cardiovascular events was high in French patients with HeFH in secondary prevention. The detection of FH during childhood is crucial to prevent CV events at a young age by early initiating statin therapy. There is a clear urgent need to expand the actual very small target population which can be treated with the PCSK9 inhibitor in France.
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Sophie Béliard, Franck Boccara, Bertrand Cariou, Alain Carrié, Xavier Collet, et al.. High burden of recurrent cardiovascular events in heterozygous familial hypercholesterolemia: The French Familial Hypercholesterolemia Registry. Atherosclerosis, Elsevier, 2018, 277, pp.334-340. ⟨10.1016/j.atherosclerosis.2018.08.010⟩. ⟨hal-01996274⟩

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