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Comparative Study
. 2019 Nov 1;4(11):1156-1159.
doi: 10.1001/jamacardio.2019.3903.

Association of Low-Density Lipoprotein Cholesterol With Risk of Aortic Valve Stenosis in Familial Hypercholesterolemia

Liv J Mundal  1 , Anders Hovland  2   3 , Jannicke Igland  4   5 , Marit B Veierød  6 , Kirsten B Holven  7   8 , Martin Prøven Bogsrud  8   9 , Grethe S Tell  5   10 , Trond P Leren  9 , Kjetil Retterstøl  1   7
Affiliations
Comparative Study

Association of Low-Density Lipoprotein Cholesterol With Risk of Aortic Valve Stenosis in Familial Hypercholesterolemia

Liv J Mundal et al. JAMA Cardiol. .

Erratum in

  • Error in Strengths/Limitations Section.
    [No authors listed] [No authors listed] JAMA Cardiol. 2019 Nov 1;4(11):1180. doi: 10.1001/jamacardio.2019.4782. JAMA Cardiol. 2019. PMID: 31746951 Free PMC article. No abstract available.

Abstract

Importance: Aortic valve stenosis (AS) is the most common valve disease. Elevated levels of low-density lipoprotein (LDL) cholesterol are a risk factor; however, lipid-lowering treatment seems not to prevent progression of AS. The importance of LDL cholesterol in the development of AS thus remains unclear. People with familial hypercholesterolemia (FH) have elevated LDL cholesterol levels from birth and until lipid-lowering treatment starts. Thus, FH may serve as a model disease to study the importance of LDL cholesterol for the development of AS.

Objective: To compare the incidence of AS per year in all genetically proven patients with FH in Norway with the incidence of these diseases in the total Norwegian population of about 5 million people.

Design, setting, and participants: This is a registry-based prospective cohort study of all Norwegian patients with FH with regard to first-time AS between 2001 and 2009. All genotyped patients with FH in Norway were compared with the total Norwegian populations through linkage with the Cardiovascular Disease in Norway project and the Norwegian Cause of Death Registry regarding occurrence of first-time AS. Data were analyzed between January 1, 2018, and December 31, 2018.

Main outcomes and measures: Standardized incidence ratios.

Results: In total, 53 cases of AS occurred among 3161 persons (1473 men [46.6%]) with FH during 18 300 person-years of follow-up. Mean age at inclusion and at time of AS were 39.9 years (range, 8-91 years) and 65 years (range, 44-88 years), respectively. Total standardized incidence ratios were 7.9 (95% CI, 6.1-10.4) for men and women combined, 8.5 (95% CI, 5.8-12.4) in women, and 7.4 (95% CI, 5.0-10.9) in men, respectively, indicating marked increased risk of AS compared with the general Norwegian population.

Conclusions and relevance: In this prospective registry study, we demonstrate a marked increase in risk of AS in persons with FH.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Holven reported grants from Mills SA, TINE, Kaneka, and Olympic Seafood; grants and personal fees from Amgen; and personal fees from Sanofi and Pronova outside the submitted work. Dr Bogsrud reported personal fees from Sanofi, Amgen, and Boehringer outside the submitted work. Dr Retterstøl reported grants from Oslo Economics through Amgen and personal fees from Amgen, Mills DA, Norwegian Medical Association, Sanofi, Chiesi, and Sunovion outside the submitted work. No other disclosures were reported.

References

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    1. Mundal LJ, Igland J, Veierød MB, et al. . Impact of age on excess risk of coronary heart disease in patients with familial hypercholesterolaemia. Heart. 2018;104(19):1600-1607. doi:10.1136/heartjnl-2017-312706 - DOI - PMC - PubMed
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    1. Bogsrud MP, Græsdal A, Johansen D, et al. . LDL-cholesterol goal achievement, cardiovascular disease, and attributed risk of Lp(a) in a large cohort of predominantly genetically verified familial hypercholesterolemia. J Clin Lipidol. 2019;13(2):279-286. doi:10.1016/j.jacl.2019.01.010 - DOI - PubMed

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