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Title: Autosomal recessive hypercholesterolemia: long-term cardiovascular outcomes
Authors: D'Erasmo, Laura
Minicocci, Ilenia
Nicolucci, Antonio
Pintus, Paolo
Roeters Van Lennep, Janine E.
Masana, Luis
Mata, Pedro
Sánchez-Hernández, Rosa Maria 
Prieto-Matos, Pablo
Real, Josè T.
Ascaso, Juan F.
Lafuente, Eduardo Esteve
Pocovi, Miguel
Fuentes, Francisco J.
Muntoni, Sandro
Bertolini, Stefano
Sirtori, Cesare
Calabresi, Laura
Pavanello, Chiara
Averna, Maurizio
Cefalu, Angelo Baldassare
Noto, Davide
Pacifico, Adolfo Arturo
Pes, Giovanni Mario
Harada-Shiba, Mariko
Manzato, Enzo
Zambon, Sabina
Zambon, Alberto
Vogt, Anja
Scardapane, Marco
Sjouke, Barbara
Fellin, Renato
Arca, Marcello
UNESCO Clasification: 3205 Medicina interna
320502 Endocrinología
Keywords: Atherosclerotic cardiovascular disease
Autosomal recessive hypercholesterolemia
Lipid-lowering therapies
Retrospective analysis
Issue Date: 2018
Journal: Journal of the American College of Cardiology 
Abstract: Background: Autosomal recessive hypercholesterolemia (ARH) is a rare lipid disorder characterized by premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data for clinical management and cardiovascular outcomes in ARH. Objectives: Evaluation of changes in lipid management, achievement of low-density lipoprotein cholesterol (LDL-C) goals and cardiovascular outcomes in ARH. Methods: Published ARH cases were identified by electronic search. All corresponding authors and physicians known to treat these patients were asked to provide follow-up information, using a standardized protocol. Results: We collected data for 52 patients (28 females, 24 males; 31.1 ± 17.1 years of age; baseline LDL-C: 571.9 ± 171.7 mg/dl). During a mean follow-up of 14.1 ± 7.3 years, there was a significant increase in the use of high-intensity statin and ezetimibe in combination with lipoprotein apheresis; in 6 patients, lomitapide was also added. Mean LDL-C achieved at nadir was 164.0 ± 85.1 mg/dl (−69.6% from baseline), with a better response in patients taking lomitapide (−88.3%). Overall, 23.1% of ARH patients reached LDL-C of <100 mg/dl. During follow-up, 26.9% of patients had incident ASCVD, and 11.5% had a new diagnosis of aortic valve stenosis (absolute risk per year of 1.9% and 0.8%, respectively). No incident stroke was observed. Age (≥30 years) and the presence of coronary artery disease at diagnosis were the major predictors of incident ASCVD. Conclusions: Despite intensive treatment, LDL-C in ARH patients remains far from targets, and this translates into a poor long-term cardiovascular prognosis. Our data highlight the importance of an early diagnosis and treatment and confirm the fact that an effective treatment protocol for ARH is still lacking.
ISSN: 0735-1097
DOI: 10.1016/j.jacc.2017.11.028
Source: Journal of the American College of Cardiology [ISSN 0735-1097], v. 71 (3), p. 279-288
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