{Reference Type}: Journal Article
{Title}: LDL cholesterol target achievement in heterozygous familial hypercholesterolemia patients according to 2019 ESC/EAS lipid guidelines: Implications for newer lipid-lowering treatments.
{Author}: Rizos CV;Skoumas I;Rallidis L;Skalidis E;Tziomalos K;Garoufi A;Anagnostis P;Sfikas G;Kotsis V;Doumas M;Kolovou G;Lambadiari V;Dima I;Kiouri E;Zacharis E;Agapakis D;Attilakos A;Antza C;Vlachopoulos C;Liberopoulos EN;
{Journal}: Int J Cardiol
{Volume}: 345
{Issue}: 0
{Year}: Dec 2021 15
{Factor}: 4.039
{DOI}: 10.1016/j.ijcard.2021.10.024
{Abstract}: <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.