Incidence of cardiovascular disease in familial combined hyperlipidemia: A 15-year follow-up study

Jim Luijten; Marleen M. J. van Greevenbroek; Nicolaas C. Schaper; Steven J. R. Meex; Caroline van der Steen; Lisanne J. Meijer; Douwe de Boer; Jacqueline de Graaf; Coen D. A. Stehouwer; Martijn C. G. J. Brouwers

doi:10.1016/j.atherosclerosis.2018.11.013

Incidence of cardiovascular disease in familial combined hyperlipidemia: A 15-year follow-up study

Jim Luijten, Marleen M. J. van Greevenbroek, Nicolaas C. Schaper, Steven J. R. Meex, Caroline van der Steen, Lisanne J. Meijer, Douwe de Boer, Jacqueline de Graaf, Coen D. A. Stehouwer, Martijn C. G. J. Brouwers^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and aims: Familial combined hyperlipidemia (FCHL) is a complex dyslipidemia associated with premature cardiovascular disease (CVD). The present study was conducted to 1) determine the incidence of CVD in FCHL in this era of protocolled, primary prevention; and 2) examine whether cardiovascular risk estimation based on the Systemic Coronary Risk Estimation (SCORE) chart, as proposed in the 2016 ESC/EAS guidelines for the management of dyslipidemia, is justified in FCHL.

Methods: FCHL patients, their normolipidemic (NL) relatives and spouses originally included in our baseline cohort in 1998-2005 (n = 596) were invited for a follow-up visit to determine the incidence of CVD, defined as (non-) fatal coronary artery disease, ischemic stroke and peripheral artery disease requiring invasive treatment.

Results: Follow-up data (median: 15 years) was acquired for 85% of the original cohort. The cumulative incidence of CVD was significantly higher in FCHL patients than in spouses (23.6% versus 4.7%; hazard ratio (HR): 5.4, 95% CI: 2.0-14.6; HR after adjustment for risk factors included in SCORE: 4.7, 95% CI: 1.6-13.8), but not in NL relatives compared to spouses (5.8% versus 4.7%). The SCORE chart tended to overestimate CVD risk in the spouses (observed [O]/expected [E] ratio: 0.2, p = 0.01), but not in FCHL patients (O/E: 1.3, p = 0.50).

Conclusions: Risk of primary CVD is still substantially increased in FCHL patients, despite preventive measures. The overestimation of CVD risk by the SCORE chart -a nowadays frequently observed phenomenon thanks to improved primary prevention - was not seen in FCHL. These results suggest that more aggressive treatment is justified to avoid excessive CVD in FCHL.

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Atherosclerosis
Volume	280
DOIs	https://doi.org/10.1016/j.atherosclerosis.2018.11.013
Publication status	Published - Jan 2019

Keywords

Familial combined hyperlipidemia
Prevention
Cardiovascular disease
Coronary artery disease
Epidemiology
Guideline
CORONARY-HEART-DISEASE
RISK SCORES
CHOLESTEROL
DIAGNOSIS
EXPRESSION
EUROPE

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10.1016/j.atherosclerosis.2018.11.013

Cite this

@article{36491292f0934f7e91ca329b956a18fc,

title = "Incidence of cardiovascular disease in familial combined hyperlipidemia: A 15-year follow-up study",

abstract = "Background and aims: Familial combined hyperlipidemia (FCHL) is a complex dyslipidemia associated with premature cardiovascular disease (CVD). The present study was conducted to 1) determine the incidence of CVD in FCHL in this era of protocolled, primary prevention; and 2) examine whether cardiovascular risk estimation based on the Systemic Coronary Risk Estimation (SCORE) chart, as proposed in the 2016 ESC/EAS guidelines for the management of dyslipidemia, is justified in FCHL.Methods: FCHL patients, their normolipidemic (NL) relatives and spouses originally included in our baseline cohort in 1998-2005 (n = 596) were invited for a follow-up visit to determine the incidence of CVD, defined as (non-) fatal coronary artery disease, ischemic stroke and peripheral artery disease requiring invasive treatment.Results: Follow-up data (median: 15 years) was acquired for 85% of the original cohort. The cumulative incidence of CVD was significantly higher in FCHL patients than in spouses (23.6% versus 4.7%; hazard ratio (HR): 5.4, 95% CI: 2.0-14.6; HR after adjustment for risk factors included in SCORE: 4.7, 95% CI: 1.6-13.8), but not in NL relatives compared to spouses (5.8% versus 4.7%). The SCORE chart tended to overestimate CVD risk in the spouses (observed [O]/expected [E] ratio: 0.2, p = 0.01), but not in FCHL patients (O/E: 1.3, p = 0.50).Conclusions: Risk of primary CVD is still substantially increased in FCHL patients, despite preventive measures. The overestimation of CVD risk by the SCORE chart -a nowadays frequently observed phenomenon thanks to improved primary prevention - was not seen in FCHL. These results suggest that more aggressive treatment is justified to avoid excessive CVD in FCHL.",

keywords = "Familial combined hyperlipidemia, Prevention, Cardiovascular disease, Coronary artery disease, Epidemiology, Guideline, CORONARY-HEART-DISEASE, RISK SCORES, CHOLESTEROL, DIAGNOSIS, EXPRESSION, EUROPE",

author = "Jim Luijten and {van Greevenbroek}, {Marleen M. J.} and Schaper, {Nicolaas C.} and Meex, {Steven J. R.} and {van der Steen}, Caroline and Meijer, {Lisanne J.} and {de Boer}, Douwe and {de Graaf}, Jacqueline and Stehouwer, {Coen D. A.} and Brouwers, {Martijn C. G. J.}",

note = "Funding Information: This work was supported by the Biobanking and Biomolecular Research Infrastructure the Netherlands ( BBMRI-NL CP2013- 80 ). Publisher Copyright: {\textcopyright} 2018 Elsevier B.V.",

year = "2019",

month = jan,

doi = "10.1016/j.atherosclerosis.2018.11.013",

language = "English",

volume = "280",

pages = "1--6",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Incidence of cardiovascular disease in familial combined hyperlipidemia

T2 - A 15-year follow-up study

AU - Luijten, Jim

AU - van Greevenbroek, Marleen M. J.

AU - Schaper, Nicolaas C.

AU - Meex, Steven J. R.

AU - van der Steen, Caroline

AU - Meijer, Lisanne J.

AU - de Boer, Douwe

AU - de Graaf, Jacqueline

AU - Stehouwer, Coen D. A.

AU - Brouwers, Martijn C. G. J.

PY - 2019/1

Y1 - 2019/1

N2 - Background and aims: Familial combined hyperlipidemia (FCHL) is a complex dyslipidemia associated with premature cardiovascular disease (CVD). The present study was conducted to 1) determine the incidence of CVD in FCHL in this era of protocolled, primary prevention; and 2) examine whether cardiovascular risk estimation based on the Systemic Coronary Risk Estimation (SCORE) chart, as proposed in the 2016 ESC/EAS guidelines for the management of dyslipidemia, is justified in FCHL.Methods: FCHL patients, their normolipidemic (NL) relatives and spouses originally included in our baseline cohort in 1998-2005 (n = 596) were invited for a follow-up visit to determine the incidence of CVD, defined as (non-) fatal coronary artery disease, ischemic stroke and peripheral artery disease requiring invasive treatment.Results: Follow-up data (median: 15 years) was acquired for 85% of the original cohort. The cumulative incidence of CVD was significantly higher in FCHL patients than in spouses (23.6% versus 4.7%; hazard ratio (HR): 5.4, 95% CI: 2.0-14.6; HR after adjustment for risk factors included in SCORE: 4.7, 95% CI: 1.6-13.8), but not in NL relatives compared to spouses (5.8% versus 4.7%). The SCORE chart tended to overestimate CVD risk in the spouses (observed [O]/expected [E] ratio: 0.2, p = 0.01), but not in FCHL patients (O/E: 1.3, p = 0.50).Conclusions: Risk of primary CVD is still substantially increased in FCHL patients, despite preventive measures. The overestimation of CVD risk by the SCORE chart -a nowadays frequently observed phenomenon thanks to improved primary prevention - was not seen in FCHL. These results suggest that more aggressive treatment is justified to avoid excessive CVD in FCHL.

AB - Background and aims: Familial combined hyperlipidemia (FCHL) is a complex dyslipidemia associated with premature cardiovascular disease (CVD). The present study was conducted to 1) determine the incidence of CVD in FCHL in this era of protocolled, primary prevention; and 2) examine whether cardiovascular risk estimation based on the Systemic Coronary Risk Estimation (SCORE) chart, as proposed in the 2016 ESC/EAS guidelines for the management of dyslipidemia, is justified in FCHL.Methods: FCHL patients, their normolipidemic (NL) relatives and spouses originally included in our baseline cohort in 1998-2005 (n = 596) were invited for a follow-up visit to determine the incidence of CVD, defined as (non-) fatal coronary artery disease, ischemic stroke and peripheral artery disease requiring invasive treatment.Results: Follow-up data (median: 15 years) was acquired for 85% of the original cohort. The cumulative incidence of CVD was significantly higher in FCHL patients than in spouses (23.6% versus 4.7%; hazard ratio (HR): 5.4, 95% CI: 2.0-14.6; HR after adjustment for risk factors included in SCORE: 4.7, 95% CI: 1.6-13.8), but not in NL relatives compared to spouses (5.8% versus 4.7%). The SCORE chart tended to overestimate CVD risk in the spouses (observed [O]/expected [E] ratio: 0.2, p = 0.01), but not in FCHL patients (O/E: 1.3, p = 0.50).Conclusions: Risk of primary CVD is still substantially increased in FCHL patients, despite preventive measures. The overestimation of CVD risk by the SCORE chart -a nowadays frequently observed phenomenon thanks to improved primary prevention - was not seen in FCHL. These results suggest that more aggressive treatment is justified to avoid excessive CVD in FCHL.

KW - Familial combined hyperlipidemia

KW - Prevention

KW - Cardiovascular disease

KW - Coronary artery disease

KW - Epidemiology

KW - Guideline

KW - CORONARY-HEART-DISEASE

KW - RISK SCORES

KW - CHOLESTEROL

KW - DIAGNOSIS

KW - EXPRESSION

KW - EUROPE

U2 - 10.1016/j.atherosclerosis.2018.11.013

DO - 10.1016/j.atherosclerosis.2018.11.013

M3 - Article

C2 - 30448567

SN - 0021-9150

VL - 280

SP - 1

EP - 6

JO - Atherosclerosis

JF - Atherosclerosis

ER -