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Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study

Iyen, Barbara; Qureshi, Nadeem; Leonardi-Bee, Jo; Kai, Joe; Akyea, Ralph K.; Roderick, Paul; Humphries, Steve E.; Weng, Stephen

Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study Thumbnail


Authors

BARBARA IYEN Barbara.Iyen2@nottingham.ac.uk
Clinical Associate Professor in Primary Care

JO LEONARDI-BEE jo.leonardi-bee@nottingham.ac.uk
Professor of Evidence Synthesis

Paul Roderick

Steve E. Humphries

Stephen Weng



Abstract

Background and aims: Familial hypercholesterolaemia (FH) is a known major cause of premature heart disease. However, the risks of atherosclerotic disease in other vascular regions are less known. We determined the risk of major cardiovascular disease (CVD) outcomes associated with clinical FH.

Methods: In a retrospective cohort study (1 January, 1999 to 22 July, 2016), we randomly-matched 14,097 UK subjects with clinical FH diagnoses or characteristics (Simon-Broome definite or Dutch Lipid Clinic Score >8) to 42,506 subjects without FH by age, sex, general practice. We excluded those with CVD at baseline. Incident rates for coronary heart disease (CHD), stroke or transient ischaemic attack (TIA) and peripheral vascular disease (PVD) were estimated. Cox proportional hazards regression, stratified on matched-pairs, determined adjusted hazards ratios (HR) for incident CVD.

Results: During follow-up (median 13.8 years), incidence rates (95% CI) of CVD (per 1000 person-years) were 25.6 (24.8–26.3) in FH and 2.9 (2.8–3.1) in non-FH subjects. The risk of CHD, stroke/TIA and PVD was higher in FH compared to non-FH subjects: CHD (HR 10.63, 95% CI 9.82–11.49), stroke/TIA (HR 6.74, 95% CI 5.84–7.77), PVD (HR 7.17, 95% CI 6.08–8.46). The risk of CVD was greater in those with FH characteristics (HR 13.52, 95% CI 12.48–14.65) than those with clinical diagnoses (HR 1.66, 95% CI 1.42–1.93).

Conclusions: In addition to the recognised increased risk of CHD, subjects with FH have greatly elevated risk of stroke/TIA and PVD. This emphasises need for early diagnosis and preventive interventions beyond CHD, to reduce CVD risk in these individuals.

Citation

Iyen, B., Qureshi, N., Leonardi-Bee, J., Kai, J., Akyea, R. K., Roderick, P., …Weng, S. (2019). Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study. Atherosclerosis, 287, 8-15. https://doi.org/10.1016/j.atherosclerosis.2019.05.017

Journal Article Type Article
Acceptance Date May 23, 2019
Online Publication Date May 24, 2019
Publication Date 2019-08
Deposit Date Jun 12, 2019
Publicly Available Date Aug 5, 2019
Journal Atherosclerosis
Print ISSN 0021-9150
Electronic ISSN 1879-1484
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 287
Pages 8-15
DOI https://doi.org/10.1016/j.atherosclerosis.2019.05.017
Keywords Cardiology and Cardiovascular Medicine
Public URL https://nottingham-repository.worktribe.com/output/2180559
Publisher URL https://www.sciencedirect.com/science/article/pii/S0021915019304423?dgcid=rss_sd_all
Additional Information This article is maintained by: Elsevier; Article Title: Risk of cardiovascular disease outcomes in primary care subjects with familial hypercholesterolaemia: A cohort study; Journal Title: Atherosclerosis; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.atherosclerosis.2019.05.017; Content Type: article; Copyright: © 2019 The Authors. Published by Elsevier B.V.
Contract Date Jun 12, 2019