Do statins reduce the incidence of stroke in familial hypercholesterolemia?

Abstract

Familial hypercholesterolemia (FH) causes lifelong elevated serum LDL-cholesterol. In untreated FH, the progression of coronary atherosclerosis and the risk of premature myocardial infarction are substantially increased. In addition, carotid artery atherosclerosis and the risk of ischemic brain infarction are increased. During the prestatin era, stroke may have been even 20-times more frequent among FH patients than in the general population. In the statin era, both registry studies and MRI studies suggest that the occurrence of ischemic brain damage is not increased among FH patients. It is likely that effective lowering of serum LDL-cholesterol levels made possible by statin treatment has been the key element behind the observed decrease in of the incidence of ischemic stroke. This idea is strongly supported by the results of a recent meta-analysis of controlled statin trials, in which statin treatment was demonstrated to lower the incidence of ischemic stroke among non-FH hypercholesterolemic patients.

Keywords::

• carotid artery atherosclerosis
• coronary atherosclerosis
• familial hypercholesterolemia
• LDL-cholesterol
• MRI
• statins
• stroke
• white-matter hyperintensities

Financial & competing interests disclosure

Petri T Kovanen has received lecture honoraria and/or consultancy fees from Merck, Pfizer and AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.