Predicting Cardiovascular Events in Familial Hypercholesterolemia
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Published:2017-05-30
Issue:22
Volume:135
Page:2133-2144
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Pérez de Isla Leopoldo1, Alonso Rodrigo1, Mata Nelva1, Fernández-Pérez Cristina1, Muñiz Ovidio1, Díaz-Díaz José Luis1, Saltijeral Adriana1, Fuentes-Jiménez Francisco1, de Andrés Raimundo1, Zambón Daniel1, Piedecausa Mar1, Cepeda José María1, Mauri Marta1, Galiana Jesús1, Brea Ángel1, Sanchez Muñoz-Torrero Juan Francisco1, Padró Teresa1, Argueso Rosa1, Miramontes-González José Pablo1, Badimón Lina1, Santos Raúl D.1, Watts Gerald F.1, Mata Pedro1
Affiliation:
1. From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.);...
Abstract
Background:
Although risk factors for atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolemia (FH) have been described, models for predicting incident ASCVD have not been reported. Our aim was to use the SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study) to define key risk factors for predicting incident ASCVD in patients with FH.
Methods:
SAFEHEART is a multicenter, nationwide, long-term prospective cohort study of a molecularly defined population with FH with or without previous ASCVD. Analyses to define risk factors and to build a risk prediction equation were developed, and the risk prediction equation was tested for its ability to discriminate patients who experience incident ASCVD from those who did not over time.
Results:
We recruited 2404 adult patients with FH who were followed up for a mean of 5.5 years (SD, 3.2 years), during which 12 (0.5%) and 122 (5.1%) suffered fatal and nonfatal incident ASCVD, respectively. Age, male sex, history of previous ASCVD, high blood pressure, increased body mass index, active smoking, and low-density lipoprotein cholesterol and lipoprotein(a) levels were independent predictors of incident ASCVD from which a risk equation with a Harrell C index of 0.85 was derived. The bootstrap resampling (100 randomized samples) of the original set for internal validation showed a degree of overoptimism of 0.003. Individual risk was estimated for each person without an established diagnosis of ASCVD before enrollment in the registry by use of the SAFEHEART risk equation, the modified Framingham risk equation, and the American College of Cardiology/American Heart Association ASCVD Pooled Cohort Risk Equations. The Harrell C index for these models was 0.81, 0.78, and 0.8, respectively, and differences between the SAFEHEART risk equation and the other 2 were significant (
P
=0.023 and
P
=0.045).
Conclusions:
The risk of incident ASCVD may be estimated in patients with FH with simple clinical predictors. This finding may improve risk stratification and could be used to guide therapy in patients with FH.
Clinical Trial Registration:
URL:
http://clinicaltrials.gov
. Unique identifier: NCT02693548.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
258 articles.
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