Long-term LDL-c lowering in heterozygous familial hypercholesterolemia normalizes carotid intima-media thickness

ObjectiveWe investigated the effectiveness of statins in daily practice in reducing the arterial wall thicknesses by comparing the carotid intima-media thickness (cIMT) between statin-treated familial hypercholesterolemia (FH) patients and their unaffected spouses.MethodsFH subjects treated with LDL-c lowering medication for at least 5 years and their unaffected spouses were included in this observational study. Clinical data and carotid intima-media thickness (cIMT) as surrogate marker for atherosclerosis were acquired.ResultsIn total 40 FH patients, age 48.4 ± 4.2 years, and their 40 unaffected spouses, age 47.4 ± 3.9 years, were included. Pre-treatment total cholesterol levels of FH patients were on average 9.3 ± 2.0 mmol/L. Treated FH patients and unaffected spouses exhibited similar LDL-c (3.8 ± 1.5 vs. 3.5 ± 1.1 mmol/L; p = 0.25) and total cholesterol levels (5.8 ± 1.6 vs. 5.6 ± 1.1 mmol/L; p = 0.56). Also, in a multivariate model cIMT adjusted for age and sex did not differ between affecteds and spouses (95% CI: −0.032 to 0.092 mm; p = 0.34).ConclusionLong-term statin treatment normalizes cIMT in severe FH patients and therefore it is likely that the extreme risk of cardiovascular disease in FH patients is significantly reduced by this therapy.