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Current Atherosclerosis Reports
Published in: Current Atherosclerosis Reports 11/2020

01-11-2020 | Atorvastatin | Statin Drugs (R. Ceska, Section Editor)

The Knowns and Unknowns of Contemporary Statin Therapy for Familial Hypercholesterolemia

Authors: Jing Pang, Dick C. Chan, Gerald F. Watts

Published in: Current Atherosclerosis Reports | Issue 11/2020

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Abstract

Purpose of Review

Statins are first-line therapy for lowering low-density lipoprotein (LDL) cholesterol in familial hypercholesterolemia (FH), particularly in heterozygous patients. We review advances and new questions on the use of statins in FH.

Recent Findings

Cumulative evidence from registry data and sub-analyses of clinical trials mandates the value of statin therapy for prevention of atherosclerotic cardiovascular disease (ASCVD) in FH. Statins are safe in children and adolescents with FH, with longer term cardiovascular benefits. The potentially toxic effects of statins in pregnancy need to be considered, but no association has been reported in prospective cohort studies with birth defects. There is no rationale for discontinuation of statins in elderly FH unless indicated by adverse events. FH is undertreated, with > 80% of statin-treated FH patients failing to attain LDL cholesterol treatment targets. This may relate to adherence, tolerability, and genetic differences in statin responsiveness. Statin treatment from childhood may reduce the need for stringent cholesterol targets. Combination of statins with ezetimibe and PCSK9 inhibitors significantly improves the efficacy of treatment. Whether statin use could improve the clinical course of FH patients with COVID-19 and other respiratory infections remains an unsolved issue for future research.

Summary

Statins are the mainstay for primary and secondary prevention of ASCVD in FH. Sustained long-term optimal statin treatment from an early age can effectively prevent ASCVD over decades of life. Despite their widespread use, statins merit further investigation in FH.
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Metadata
Title
The Knowns and Unknowns of Contemporary Statin Therapy for Familial Hypercholesterolemia
Authors
Jing Pang
Dick C. Chan
Gerald F. Watts
Publication date
01-11-2020
Publisher
Springer US
Published in
Current Atherosclerosis Reports / Issue 11/2020
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-020-00884-2

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