Publication details

Comparison of the characteristics at diagnosis and treatment of children with heterozygous familial hypercholesterolaemia (FH) from eight European countries

Authors	RAMASWAMI U. FUTEMA M. BOGSRUD M. P. HOLVEN K. B. VAN LENNEP J. R. WIEGMAN A. DESCAMPS O. S. VRABLIK M. FREIBERGER Tomáš DIEPLINGER H. GREBER-PLATZER S. HANAUER-MADER G. BOURBON M. DROGARI E. HUMPHRIES S. E.
Year of publication	2020
Type	Article in Periodical
Magazine / Source	Atherosclerosis
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.atherosclerosis-journal.com/article/S0021-9150(19)31569-2/pdf
Doi	http://dx.doi.org/10.1016/j.atherosclerosis.2019.11.012
Keywords	Heterozygous familial hypercholesterolaemia; Paediatric FH; LDL-C concentrations; Statin treatment
Description	Background and aims: For children with heterozygous familial hypercholesterolaemia (HeFH), European guidelines recommend consideration of statin therapy by age 8-10 years for those with a low density lipoprotein cholesterol (LDL-C) > 3.5 mmol/l, and dietary and lifestyle advice. Here we compare the characteristics and lipid levels in HeFH children from Norway, UK, Netherlands, Belgium, Czech Republic, Austria, Portugal and Greece. Methods: Fully-anonymized data were analysed at the London centre. Differences in registration and on treatment characteristics were compared by standard statistical tests. Results: Data was obtained from 3064 children. The median age at diagnosis differed significantly between countries (range 3-11 years) reflecting differences in diagnostic strategies. Mean (SD) LDL-C at diagnosis was 5.70 (+/- 1.4) mmol/l, with 88% having LDL-C > 4.0 mmol/l. The proportion of children older than 10 years at follow-up who were receiving statins varied significantly (99% in Greece, 56% in UK), as did the proportion taking Ezetimibe (0% in UK, 78% in Greece). Overall, treatment reduced LDL-C by between 28 and 57%, however, in those > 10 years, 23% of on-treatment children still had LDL-C > 3.5 mmol/l and 66% of those not on a statin had LDL-C > 3.5 mmol/l. Conclusions: The age of HeFH diagnosis in children varies significantly across 8 countries, as does the proportion of those > 10 years being treated with statin and/or ezetimibe. Approximately a quarter of the treated children and almost three quarters of the untreated children older than 10 years still have LDL-C concentrations over 3.5 mmol/l. These data suggest that many children with FH are not receiving the full potential benefit of early identification and appropriate lipid-lowering treatment according to recommendations.