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Familial hypercholesterolemia and acute coronary syndrome. Is it a failure in primary prevention?

Session Poster Session 2

Speaker Andrea Velez Salas

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2018

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention - Epidemiology
  • Session type : Poster Session

Authors : A Velez Salas (Madrid,ES), ARP Adrian Rivas (Madrid,ES), FJI Francisco Javier Irazusta (Madrid,ES), RDG Regina Dalmau (Madrid,ES), ACF Almudena Castro (Madrid,ES), JLS Jose Luis Lopez Sendon (Madrid,ES)

Authors:
A Velez Salas1 , ARP Adrian Rivas1 , FJI Francisco Javier Irazusta1 , RDG Regina Dalmau1 , ACF Almudena Castro1 , JLS Jose Luis Lopez Sendon1 , 1University Hospital La Paz - Madrid - Spain ,

Citation:
European Journal of Preventive Cardiology ( May 2018 ) 25 ( Supplement 1 ), 80

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.


Group 1 (N=35)
Group2 (N=1143)
P value
Age (mean±SD)

52,7±10.1

57.5±10.7 0.007
Sex (male) 25 (71.4%) 850 (83.7%) 0.111
Hypertension 12 (34.4%) 518 (51.1%) 0.029
Diabetes mellitus 7 (20%) 259 (25.8%) 0.444
Smoker 24 (64.9%) 532 (52.4%) 0.179
IMC>30 12 (34.4%) 252 (25.5%) 0.243
Severe CHD(1) 13 (32.7%) 258 (26.8%) 0.180
Not achievement of LDL target (2) 24 (75%) 425 (47%) 0.03
(1) Coronary angiography with ≥3 coronary lesions (2) LDL>70mg/dl at the end of CRP

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