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Long-term effect of 2 intensive statin regimens on treatment and incidence of cardiovascular events in familial hypercholesterolemia: The SAFEHEART study

AuthorsPérez de Isla, Leopoldo; Arroyo-Olivares, Raquel; Muñiz Grijalvo, Ovidio; Diaz-Diaz, Jose Luis; Zambón, Daniel; Fuentes, Francisco; Sánchez Muñoz-Torrero, Juan F.; Mediavilla, Juan Diego; González-Estrada, Aurora; Miramontes González, José Pablo; Andrés, Raimundo de; Mauri, Marta; Mosquera, Daniel; Cepeda, José M.; Suárez, Lorena; Barba-Romero, Miguel Ángel; Argüeso, Rosa; Álvarez-Baños, Pilar; Michán, Alfredo; Romero-Jiménez, Manuel J.; García-Cruces, Jesús; Padró, Teresa; Alonso, Rodrigo; Mata, Pedro
KeywordsFamilial hypercholesterolemia
Long-term prognosis
Issue DateNov-2019
CitationJournal of Clinical Lipidology 13(6): 986-996 (2019)
Abstract[Background] Maximal doses of potent statins are the basement of treatment of familial hypercholesterolemia (FH). Little is known about the use of different statin regimens in FH.
[Objectives] The objectives of the study were to describe the treatment changes and low-density lipoprotein cholesterol (LDL-C) goal achievement with atorvastatin (ATV) and rosuvastatin (RV) in the SAFEHEART cohort, as well as to analyze the incidence of atherosclerotic cardiovascular events (ACVEs) and changes in the cardiovascular risk.
[Methods] SAFEHEART is a prospective follow-up nationwide cohort study in a molecularly defined FH population. The patients were contacted on a yearly basis to obtain relevant changes in life habits, medication, and ACVEs.
[Results] A total of 1939 patients were analyzed. Median follow-up was 6.6 years (5–10). The estimated 10-year risk according the SAFEHEART risk equation was 1.61 (0.67–3.39) and 1.22 (0.54–2.93) at enrollment for ATV and RV, respectively (P < .001). There were no significant differences at the follow-up: 1.29 (0.54–2.82) and 1.22 (0.54–2.76) in the ATV and RV groups, respectively (P = .51). Sixteen percent of patients in primary prevention with ATV and 18% with RV achieved an LDL-C <100 mg/dL and 4% in secondary prevention with ATV and 5% with RV achieved an LDL-C <70 mg/dL. The use of ezetimibe was marginally greater in the RV group. One hundred sixty ACVEs occurred during follow-up, being its incidence rate 1.1 events/100 patient-years in the ATV group and 1.2 in the RV group (P = .58).
[Conclusion] ATV and RV are 2 high-potency statins widely used in FH. Although the reduction in LDL-C levels was greater with RV than with ATV, the superiority of RV for reducing ACVEs was not demonstrated.
Publisher version (URL)http://dx.doi.org/10.1016/j.jacl.2019.10.005
Identifiersdoi: 10.1016/j.jacl.2019.10.005
issn: 1933-2874
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