Endocrine Abstracts

Background: In the UK, NICE guidelines for familial hypercholesterolaemia (FH) recommend a greater than 50% reduction in low-density lipoprotein-cholesterol (LDL-C) as the therapeutic target. However, despite the availability of a range of lipid lowering medication, this target is often difficult to achieve and, more importantly, maintain life-long. Understanding factors that affect LDL-C target achievement is key to reducing cardiovascular disease (CVD) risk. Currently, there is a paucity of evidence regarding goal achievement among FH patients in the United Kingdom.

Methods: A retrospective longitudinal study was conducted using data from patients followed-up at a tertiary centre lipid-clinic. The primary outcome was attainment of a ≥50% LDL-C reduction from their baseline LDL-C reading at the end of the follow-up. Contributing clinical factors which impact on target achievement were assessed.

Results: Seventy genetically diagnosed heterozygous FH patients were included (mean follow-up 28±9.3 years), of which 75.6% of patients achieved ≥50% LDL-C reduction by the end of the follow-up. Treatment with high intensity statins and combined therapy with statin and ezetimibe were significantly associated with a higher rate of ≥50% LDL-C reduction. Patients who achieved the NICE LDL-C target had a significantly higher frequency of outpatient follow-up visits per year compared to those who did not achieve their target (1.7±0.4 vs 1.1±0.3 visits per year P<0.0001). There was a significant, negative correlation between frequency of follow-up and change in LDL-C from baseline (rs=-0.50, P<0.0001).

Conclusions: The more frequently FH patients are followed-up at a specialised centre, the more likely they are to achieve the NICE LDL-C target. Cost benefit analyses are needed to determine whether following patients up more frequently is economically beneficial. Additionally, future works could explore the impact of increased follow-up in primary care on LDL-C goal achievement.