The edition · Cardiology
Familial hypercholesterolaemia treated from age 14: 0.3% had a cardiovascular event by 39, against 5.2% of their parents
A Spanish family cohort makes the case for treating FH in childhood; hsCRP outperforms IL-6 after ACS; low Lp(a) looks safe except for a small diabetes signal; SGLT2 inhibitors raise haemoglobin by 0.6 g/dL; and a multisociety statement on female-specific prevention.
The edition in brief
SAFEHEART followed 348 children with genetically confirmed heterozygous familial hypercholesterolaemia, their unaffected siblings and 288 affected parents for a median 12.4 years. Children started lipid-lowering at a median 14.5 years against 36.1 in their parents, carried about half the lifetime LDL burden by their thirties, and by age 39 had a cardiovascular event rate of 0.3% against 5.2% in parents. The design is observational. In 11,817 post-ACS patients from ODYSSEY OUTCOMES, hsCRP independently predicted major cardiovascular events while IL-6 did not; both predicted death, and risk rose only when both were raised. In FOURIER, low Lp(a), even 13 nmol/L or less, was not associated with bleeding, haemorrhagic stroke, neurocognitive events, cancer or atrial fibrillation, but each 50 nmol/L lower Lp(a) carried a 5% higher hazard of incident diabetes. A JAMA meta-analysis of 85 randomised trials found SGLT2 inhibitors raised haemoglobin by 0.60 g/dL and haematocrit by 2.4 points, with a small fall in transferrin saturation. The AHA, AAP, ACOG and SMFM have issued consensus guidance organising female cardiovascular prevention around four life stages, with pregnancy as a modifying event.
After ACS, hsCRP predicted events independently of IL-6; IL-6 did not
hsCRP remains the practical inflammatory marker after ACS; routine IL-6 testing adds little for event prediction.
Very low Lp(a) in FOURIER: no safety signal apart from more diabetes
Low Lp(a) looks safe on most outcomes; the diabetes association is small and did not appear with evolocumab.
SGLT2 inhibitors raise haemoglobin by about 0.6 g/dL
Expect a modest haemoglobin rise on SGLT2 inhibitors and keep checking iron in heart failure and CKD.
Female-specific cardiovascular prevention organised by four life stages
Take a reproductive history as part of every woman's cardiovascular risk assessment.
Cascade testing: one FH diagnosis should lead to the family
When you diagnose familial hypercholesterolaemia, test the family, starting with the children.
Treating familial hypercholesterolaemia from adolescence nearly halved lifetime LDL exposure
Find familial hypercholesterolaemia in children through their parents and consider treatment from adolescence.
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