Published 11 November 2008, doi:10.1136/bmj.a2423
Cite this as: BMJ 2008;337:a2423

Research

Efficacy of statins in familial hypercholesterolaemia: a long term cohort study

Jorie Versmissen, researcher1, Daniëlla M Oosterveer, researcher1, Mojgan Yazdanpanah, epidemiologist1, Joep C Defesche, senior researcher2, Dick C G Basart, clinician3, Anho H Liem, clinician4, Jan Heeringa, statistician5, Jacqueline C Witteman, professor of epidemiology5, Peter J Lansberg, clinician2, John J P Kastelein, professor of vascular medicine2, Eric J G Sijbrands, associate professor1

1 Department of Internal Medicine, Erasmus University Medical Centre, PO box 2040, 3000 CA Rotterdam, Netherlands, 2 Department of Vascular Medicine, Academic Medical Centre, PO box 22660, 1100 DD Amsterdam, Netherlands, 3 Department of Cardiology, Westfries Gasthuis, PO box 600, 1620 AR Hoorn, Netherlands, 4 Department of Cardiology, Oosterschelde Hospital, PO box 106, 4460 BB Goes, Netherlands, 5 Department of Epidemiology and Biostatistics, Erasmus University Medical Centre, Rotterdam

Correspondence to: E J G Sijbrands e.sijbrands{at}erasmusmc.nl

Objective To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia.

Design Cohort study with a mean follow-up of 8.5 years.

Setting 27 outpatient lipid clinics.

Subjects 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990.

Main outcome measures Risk of coronary heart disease in treated and "untreated" (delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable.

Results In January 1990, 413 (21%) of the patients had started statin treatment, and during follow-up another 1294 patients (66%) started after a mean delay of 4.3 years. Most patients received simvastatin (n=1167, 33 mg daily) or atorvastatin (n=211, 49 mg daily). We observed an overall risk reduction of 76% (hazard ratio 0.24 (95% confidence interval 0.18 to 0.30), P<0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age-matched sample from the general population (hazard ration 1.44 (0.80 to 2.60), P=0.23).

Conclusion Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population.


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This article has been cited by other articles:

  • Mascitelli, L., Pezzetta, F., Goldstein, M. R. (2009). Are Statin Effects Mediated Through, or in Spite of, Their Cholesterol-lowering Action?. ANGIOLOGY 60: 262-263  
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