Homozygous familial hypercholesterolemia (HoFH), which affects 1 in a million individuals, leads to extremely elevated levels of cholesterol and early-onset cardiovascular disease.
The aim of this study was to assess all 7 HoFH patients treated with low-density lipoprotein (LDL) apheresis in Norway with respect to quality of life, clinical and laboratory assessments, and cardiovascular status.
Apheresis treatment and assessment of cardiovascular status was performed at local hospitals but coordinated by the Lipid Clinic that has followed all patients since diagnosis. Quality of life was evaluated by a validated questionnaire.
Results are shown as median (min-max). LDL cholesterol at diagnosis (untreated) was 704 (592-1268) mg/dL (18.2 [15.3-32.8] mmol/L). Medication was initiated at age 9 (2-35) years, and apheresis treatment at age 10 (6-44) years. Regular once-weekly apheresis combined with the maximum-tolerable doses of a statin and ezetimibe reduced LDL cholesterol to 197 (170-282) mg/dL (5.1 [4.5-7.3] mmol/L) pre-apheresis and 85 (50-108) mg/dL (2.2 [1.3-2.8] mmol/L) post-apheresis. Calculated interval mean LDL cholesterol was 162 (135-220) mg/dL (4.2 [3.5-5.7] mmol/L). Duration of apheresis treatment was 11 (1-24) years. Cardiovascular manifestations progressed in most patients despite the apheresis treatment. The subjects' quality of life was comparable with that of a healthy population, with the exception of two patients, who were significantly affected by coronary disease.
Well-tolerated, once-weekly LDL apheresis achieves lower interval mean LDL cholesterol levels between apheresis treatments than previously reported for apheresis every second week. However, progressions of cardiovascular manifestations still occurred, which highlights the importance of earlier and even more aggressive treatment and follow-up in HoFH.
Because of the potential for large variability among countries in the utilization and cost of health care resources, it is important to assess the appropriateness of combining economic data across the countries in a multinational clinical economic trial. We show how available tests for interaction can be applied to economic endpoints, including cost-effectiveness ratios and net health benefits. This analysis includes a characterization of possible interactions being quantitative or qualitative in nature. In the absence of interaction, a pooled estimate of the economic endpoint should be representative of the participating countries. We explore the analytic issues by further analysing data from the Scandinavian Simvastatin Survival Study (4S).
The authors evaluated the association between plasma vitamin E content and progression of eye lens opacities. A total of 410 hypercholesterolemic eastern Finnish men participated in the study from January 1990 to September 1993 in Kuopio, Finland. Lens opacities were classified three times at 18-month intervals using the Lens Opacities Classification System II. A low plasma vitamin E level (lowest quartile) was associated with a 3.7-fold excess risk (95% confidence interval 1.2-11.8) of the progression of early cortical lens opacities compared with the highest quartile (p = 0.028). In addition, the number of cigarettes smoked daily was a significant predictor of the progression of cortical lens opacity (relative risk = 1.06 per cigarette, 95% confidence interval 1.003-1.12). The progression of nuclear lens opacities was not associated with either the plasma vitamin E content or smoking. The data suggest that low plasma vitamin E content may be associated with increased risk of the progression of early cortical lens opacity.
This study aimed to investigate the association of lipoprotein and triglyceride levels with all-cause mortality in a population free from diabetes and cardiovascular disease (CVD) at baseline. The European Guidelines on cardiovascular disease prevention state that in general total cholesterol (TC) should be
OBJECTIVE: To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician. METHODS: In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre. RESULTS: Hypertensive women more often reached target systolic/diastolic blood pressure levels (
Atherosclerosis is related to serum lipids, whereas restenosis after coronary angioplasty is probably not, reflecting different pathophysiologies. Nonetheless, treatment of lipid disorders is appropriate after angioplasty.
Hydroxymethylglutaryl-CoA reductase inhibitors (statins) reduce cardiovascular events in hypertensive subjects, but their effect on carotid BP, pressure augmentation, and wave reflection is unknown. We compared the effect of atorvastatin with placebo in a substudy of the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA). Hypertensive patients (n=142; age=43 to 79 years; 127 male) with total cholesterol
Clinical studies have demonstrated the benefit of lowering cholesterol in decreasing coronary complications. These results need to be implemented in clinical practice, where an important barrier are the attitudes of physicians.
General practitioners in the city of Helsinki were asked to respond to two questionnaires sent to them by post 12 months apart (1996 and 1997); 284 responses were received in 1996 and 258 in 1997.
In addition to brief questions aimed to characterize the responding physician, the questionnaire included four examples of patients: (1) middle-aged man without, or (2) with coronary heart disease (CHD); (3) 70-year-old man with a history of stroke; (4) 70-year-old women with CHD. The physicians were asked at what level of serum low-density-lipoprotein (LDL) cholesterol they usually initiate drug therapy. Comparisons were made longitudinally between 1996 and 1997, as well as between different patients. Analyses are based on the responses of those physicians who reported that they treat atherosclerotic patients (241 and 237 in 1996 and 1997, respectively).
In case 1 (primary prevention), 40.1% of general practitioners in 1996 compared with 52.4% in 1997 (difference +12.3, 95% CI +3.2(-)+20.9, P
In clinical trials, cholesterol-lowering medications have been proven to decrease mortality and morbidity and are strongly recommended as secondary prevention in patients with established coronary artery disease. In routine practice, the translation of these benefits to elderly patients with recent coronary revascularization is less well known.
Using the provincial computerized administrative databases of the Régie de l'Assurance Maladie du Québec, we identified all elderly patients (>65 years old) in Quebec, Canada, discharged alive after a coronary revascularization procedure (percutaneous coronary intervention or coronary artery bypass graft) between April 1, 1995, and December 31, 1997, and determined the percentage fulfilling prescriptions for cholesterol-lowering drug therapy. Time-dependent multivariable models examined the clinical end points of total mortality, acute myocardial infarctions, and repeat coronary revascularizations as a function of cholesterol-lowering drug exposure. Patients were followed up until death or December 31, 1999.
We identified 11958 elderly patients who had a coronary revascularization between April 1, 1995, and December 31, 1997. During an average 3-year follow-up, users of cholesterol-lowering medications had a decreased risk of death [hazard ratio (HR) 0.66, 95% CI 0.45-0.96] or myocardial infarction (HR 0.77, 95% CI 0.54-1.11) but no reduction in repeat revascularizations (HR 1.06, 95% CI 0.88-1.28).
In this population-based study of recently revascularized elderly patients, we observed health benefits associated with the use of cholesterol-lowering medications of similar size to those seen in randomized clinical trials. The translation of these benefits from clinical trials to a nonselected population of revascularized patients emphasizes the importance of this aspect of secondary prevention in clinical practice.