Introduction: Familial hypercholesterolemia (FH) is a common cause of premature coronary heart disease (CHD). However, it is often diagnosed only after an acute event, delaying the appropriate treatment of these patients and the screening of their relatives.
Purpose: To know the proportion of patients with severe hypercholesterolemia (defined as LDL-c>190mg/dl) that were diagnosed and treated before a first coronary event, and to find out whether FH was suspected or confirmed after their admission.
Methods: Retrospective analysis of 1178 patients that completed a Cardiac Rehabilitation Program (CRP) after an acute coronary syndrome (ACS) between 2009-2014. We compared baseline characteristics, LDL target achievement and extension of CHD between patients with severe hypercholesterolemia after an ACS and the rest of the cohort. Furthermore, we identified the probable and definitive cases of FH according to the Dutch Lipid Clinic Network Criteria.
Results: Thirty-five patients had LDL>190mg/dl (2.97%), of which only 4 patients (11.4%) received lipid lowering treatment before admission. This high-LDL group was younger (52.7 vs. 57.5 years, p<0.01) and had a lower proportion of hypertension. There were no differences regarding other cardiovascular risk factors or the extension of the CHD (table 1). The LDL target at the end of CRP was not achieved in a higher proportion of patients of the LDL>190 group (75% vs. 47.7%, p=0.03). Thirteen cases of probable HF were identified, of which only 5 cases were genetically tested.
Conclusions: Most patients with very high levels of LDL after an ACS do not have previous diagnosis or treatment for hypercholesterolemia. Furthermore, they have an early onset of CHD and worse LDL target achievement. This highlights the need of actively search for patients that meet criteria of FH to prevent premature coronary events, optimize their treatment and carry out familiar screening.
(1) Coronary angiography with ≥3 coronary lesions (2) LDL>70mg/dl at the end of CRP