Diabetogenic effects of high intensity statin treatment in heterozygous familial hypercholesterolemia and familial combined hyperlipidemia

Background: Cataracts are the main cause of blindness and represent one fifth of visual problems worldwide. It is still unknown whether prolonged statin treatment favors the development of cataracts. We aimed to ascertain the prevalence of cataract surgery in elderly subjects with genetically diagnosed heterozygous familial hypercholesterolemia (HeFH) receiving statin treatment for ≥5 years, and compare this with controls. Methods: This is an observational, multicenter, case–control study from five lipid clinics in Spain. We collected data with the following inclusion criteria: age ≥65 years, LDL cholesterol levels ≥220 mg/dL without lipid-lowering drugs, a pathogenic mutation in a candidate gene for HeFH (LDLR, APOB, or PCSK9) and statin treatment for ≥5 years. Controls were selected from relatives of HeFH patients without hypercholesterolemia. Linear and logistic regressions based on generalized linear models and generalized estimating equations (GEE) were used. Cataract surgery was used as a proxy for cataract development. Results: We analyzed 205 subjects, 112 HeFH, and 93 controls, with a mean age of 71.8 (6.5) and 70.0 (7.3) years, respectively. HeFH subjects presented no difference in clinical characteristics, including smoking, hypertension, and type 2 diabetes mellitus, compared with controls. The mean duration of lipid-lowering treatment in HeFH was 22.5 (8.7) years. Cataract surgery prevalence was not significantly different between cases and controls. The presence of cataracts was associated neither with LDLc nor with the length of the statin therapy. Conclusion: In the present study, HeFH was not a risk factor for cataract surgery and prolonged statin treatment did not favor it either. These findings suggest that statin treatment is not related with cataracts.

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Subclinical coronary atherosclerosis and cardiovascular risk stratification in heterozygous familial hypercholesterolemia patients undergoing statin treatment

Current Opinion in Lipidology ◽

10.1097/mol.0000000000000573 ◽

2019 ◽

Vol 30 (2) ◽

pp. 82-87 ◽

Cited By ~ 4

Author(s):

Marcio H. Miname ◽

Marcio S. Bittencourt ◽

Khurram Nasir ◽

Raul D. Santos

Keyword(s):

Cardiovascular Risk ◽

Risk Stratification ◽

Familial Hypercholesterolemia ◽

Coronary Atherosclerosis ◽

Statin Treatment ◽

Cardiovascular Risk Stratification ◽

Heterozygous Familial Hypercholesterolemia

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Statin therapy and risk of diabetes in patients with heterozygous familial hypercholesterolemia or familial combined hyperlipidemia

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.08.047 ◽

2014 ◽

Vol 237 (1) ◽

pp. 140-145 ◽

Cited By ~ 28

Author(s):

John Skoumas ◽

Catherine Liontou ◽

Christina Chrysohoou ◽

Constantina Masoura ◽

Konstantinos Aznaouridis ◽

...

Keyword(s):

Statin Therapy ◽

Familial Hypercholesterolemia ◽

Familial Combined Hyperlipidemia ◽

Heterozygous Familial Hypercholesterolemia

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Abstract 035: Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among Individuals With Familial Hypercholesterolemia in the U.S. (1999-2014)

Circulation ◽

10.1161/circ.137.suppl_1.035 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Emily M Bucholz ◽

Angie M Rodday ◽

Katherine Kolor ◽

Muin Khoury ◽

Sarah D deFerranti

Keyword(s):

Statin Therapy ◽

Familial Hypercholesterolemia ◽

High Intensity ◽

Statin Treatment ◽

Usual Source Of Care ◽

Uninsured Patients ◽

Cholesterol Screening ◽

Source Of Care ◽

The U.S ◽

Statin Use

Background: Familial hypercholesterolemia (FH) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD); however, recent data from ambulatory care centers suggests that prescription rates for statins remain low in patients with severe dyslipidemia or diagnosed FH. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. Methods: Data from the 1999 to 2014 National Health and Nutrition Examination Survey (NHANES) were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among U.S. adults ≥20 years of age (n=42,471 weighted to represent 212 million U.S. adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol (LDL-C) levels ≥190mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. Results were extrapolated to the U.S. adult population. Results: The US prevalence of definite/probable FH was 0.47% (standard error 0.03%) and of severe dyslipidemia was 6.59% (SE 0.17%). Rates of cholesterol screening and awareness were high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% (SE 8.2%) of adults with definite/probable FH and 37.6% (SE 1.2%) of adults with severe dyslipidemia). Less than half of those on statins were prescribed a high-intensity statin. The prevalence of statin use in adults with definite/probable FH and severe dyslipidemia increased slightly over time but not faster than trends in the general population. Older age, insurance, having a usual source of care, diabetes, hypertension, and having a personal history of early ASCVD were associated with statin use. The discrepancy between cholesterol screening and treatment rates was most pronounced in younger patients, uninsured patients, and patients without a usual source of care. Conclusions: Despite high rates of cholesterol screening and awareness, only about half of U.S adults with FH are on statin therapy and even fewer are prescribed a high-intensity statin; young and uninsured patients are at the highest risk for under treatment. A low rate of statin use in young adults is of particular relevance given the early onset of ASCVD in adults with FH. This study highlights an opportunity and an imperative to improve statin treatment rates in this high-risk population. Additional studies are needed to better understand how to close the gap between screening and treatment among adults with FH and improve treatment rates among those with limited access to care.

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