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Aug 27, 2016

Despite Statins, Familial Hypercholesterolemia Doubles Risk for Second Heart Attack

Study authors emphasize screening for the genetic disorder that causes dangerously high cholesterol.

Despite widespread statin use among heart attack survivors, patients with a genetic disorder causing high cholesterol have significantly increased risk for a second heart event, according to results of a large Swiss study.

Published in the American Heart Association journal Circulation, this study analyzed outcomes among heart attack survivors with familial hypercholesterolemia. Familial hypercholesterolemia is a common genetic disorder that causes dangerously high levels of LDL or “bad” cholesterol, beginning at birth. Unfortunately, familial hypercholesterolemia (FH) tends to accelerate the development of heart disease, especially when left untreated. Once patients with FH develop heart disease, their risk for future heart events and death is significantly increased.

The good news, however, is that cholesterol-lowering statins help improve outcomes after heart attack. Experts wonder if increased statin use helps offset increased cardiovascular risk from FH after a heart attack.

To learn more, researchers analyzed data from more than 4,500 patients hospitalized for acute coronary syndrome in Switzerland. Acute coronary syndrome is an umbrella term used for situations where blood supply to the heart is blocked, like during heart attack or severe episodes of chest pain.

Based on screenings, researchers found that anywhere from 2–5% of patients had familial hypercholesterolemia, depending on the criteria used to define FH. And while up to 99% of patients with FH were prescribed statins after hospitalization, their cardiovascular risk remained high.

After adjusting for factors like age and weight, patients with FH were 2–3 times more likely to experience a heart event within the first year after hospitalization than those without FH. Overall, patients with FH were more than ten years younger than heart attack survivors without FH.

The take-home message, as authors explain, is that screening for FH is critical among heart attack survivors. Patients with FH and history of heart attack have significantly increased risk for future heart events, despite the use of cholesterol-lowering statins. As findings suggest, it’s important that patients with FH receive individualized treatment to help reduce their cardiovascular risk after heart attack.

Questions for You to Consider

  • What are symptoms of familial hypercholesterolemia (FH)?
  • Symptoms of FH include fatty skin deposits on or around the hands, elbows, knees, ankles and the eyes, and cholesterol deposits on the eyelids. Individuals with FH may also experience chest pain or other signs of heart disease, even at a young age.
  • How is familial hypercholesterolemia (FH) diagnosed?
  • FH is typically diagnosed through blood tests that measure cholesterol levels, a physical examination and a review of family medical history. Genetic tests may also be used to diagnose FH. Once FH is diagnosed, the goal of treatment is to reduce the risk of heart disease.


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