%0 Journal Article
%T LDL cholesterol target achievement in heterozygous familial hypercholesterolemia patients according to 2019 ESC/EAS lipid guidelines: Implications for newer lipid-lowering treatments.
%A Rizos CV
%A Skoumas I
%A Rallidis L
%A Skalidis E
%A Tziomalos K
%A Garoufi A
%A Anagnostis P
%A Sfikas G
%A Kotsis V
%A Doumas M
%A Kolovou G
%A Lambadiari V
%A Dima I
%A Kiouri E
%A Zacharis E
%A Agapakis D
%A Attilakos A
%A Antza C
%A Vlachopoulos C
%A Liberopoulos EN
%J Int J Cardiol
%V 345
%N 0
%D Dec 2021 15
%M 34687802
%F 4.039
%R 10.1016/j.ijcard.2021.10.024
%X <B>BACKGROUND: </B>The 2019 European guidelines (ESC/EAS) for the treatment of dyslipidaemias recommend more aggressive targets for low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia (FH). Current lipid-lowering treatment is often inadequate to achieve these targets.<BR><B>METHODS: </B>Data from the HELLAS-FH registry were analysed to assess achievement of LDL-C targets in adults with FH based on the 2019 ESC/EAS guidelines. In patients who had not achieved LDL-C target, the maximally reduced LDL-C value was calculated after theoretical switch to rosuvastatin/ezetimibe 40/10 mg/day. The percentage of patients who remained candidates for proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) was then calculated.<BR><B>RESULTS: </B>Patients (n = 1694, mean age 50.8 ± 14.7 years) had LDL-C levels 242 ± 71 mg/dL (6.3 ± 1.8 mmol/L) at diagnosis. Most treated patients were receiving statins (97.5%) and about half were on additional ezetimibe (47.5%). Based on the 2019 ESC/EAS guidelines the percentage of patients achieving LDL-C goals was only 2.7%. Following theoretical up titration to rosuvastatin/ezetimibe 40/10 mg, LDL-C target achievement rate would increase to 5.9%. In this scenario, most patients (55.9%) would be eligible for PCSK9i treatment. Following theoretical administration of a PCSK9i, LDL-C target achievement rate would rise to 57.6%. However, 42.4% of patients would still be eligible for further LDL-C lowering treatment.<BR><B>CONCLUSIONS: </B>Most FH patients do not reach new LDL-C targets even if on maximum intensity statin/ezetimibe treatment. In this case, more than half of FH patients are candidates for PCSK9i therapy and a considerable proportion may still require additional LDL-C lowering.