Attainment of the low-density lipoprotein cholesterol treatment target and prognosis of heterozygous familial hypercholesterolemia

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Abstract Background and aims No previous study has investigated the association between attainment of low-density lipoprotein (LDL) cholesterol treatment target and better prognosis in patients with familial hypercholesterolemia (FH). The current research aimed to examine the association between attainment of LDL cholesterol treatment target and major adverse cardiac events (MACEs) in patients with FH to validate the current LDL cholesterol treatment targets in primary (< 100 mg/dL) and secondary (< 70 mg/dL) prevention settings. Methods The data of patients with FH who were admitted to our university hospital between 2000 and 2020 and who were followed-up were retrospectively reviewed. The number of MACEs, including mortality associated with cardiovascular disease, unstable angina, and myocardial infarction per 1,000 person-years, was calculated for each stratum for the attainment of LDL cholesterol target. Results The median follow-up duration was 12.6 years. In total, 132 MACEs were recorded during the follow-up period. The numbers of patients who attained the LDL cholesterol target in the primary and secondary prevention groups were 228 (31.9%) and 40 (11.9%), respectively. The event rates per 1,000 person-years for LDL cholesterol levels of < 100 and ≥ 100 mg/dL in the primary prevention group were 2.6 and 4.4, respectively. The event rates per 1,000 person-years for LDL cholesterol levels of < 70 and ≥ 70mg/dL in the secondary prevention group were 15.3 and 27.5, respectively. Conclusion Attainment of the LDL cholesterol target is associated with better prognosis in patients with FH. However, the attainment rate is currently inadequate among Japanese.