At the European Atherosclerosis Society (EAS) in Praque, Professor Børge Nordestgaard (Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark) showed data from the Copenhagen General Population Study in which a 2.6-fold increased risk of ischaemic stroke in patients with clinical familial hypercholesterolaemia (FH) was observed compared with patients who were unlikely to have FH. Risk was even higher in those with pre-existing ischaemic heart disease.

According to Prof. Nordestgaard, it is interesting that this increased risk was secondary to the development of ischaemic heart disease. This might suggest that the level of low-density lipoprotein cholesterol (LDL-C) is not the direct driver of ischaemic stroke.

For clinicians, the take home message should be to consider the possibility of atherosclerotic vascular disease in other vascular regions beyond the coronary circulation in familial hypercholesterolaemia.

The investigators showed that those people with a definite or probable diagnosis of clinical FH (based on the modified Dutch Lipid Clinic Network [DLCN] criteria) had a 2.6-fold risk of ischaemic stroke compared with patients unlikely to have FH. Even in individuals with a possible diagnosis of clinical FH (n=6,325), there was a 30% higher risk of ischaemic stroke. Heart attack in middle age is the hallmark of untreated FH. There is also evidence to suggest that the cumulative burden of high LDL-C levels can predispose to atherosclerotic complications in other vascular beds. This report has shown that clinical FH is associated with a high risk for ischaemic stroke, especially in people with definite clinical FH who already have had a heart attack, where the risk of ischaemic stroke is increased by nearly 6-fold (hazard ratio for risk 5.95 versus 1.51 in people with definite clinical FH but without any previous clinical events).

The study enrolled randomly selected adults from all regions of Copenhagen and the surrounding area. The current report used data from 104,763 individuals in this study (n=315 with clinical FH and 98,123 unlikely to have FH). In follow-up over 11 years, there were 1,554 cases of ischaemic stroke.

The findings of this study reinforce the importance of early detection and early treatment of FH patients, not only to prevent early heart attack, but also to prevent other cardiovascular complications including stroke, which is a debilitating and costly condition to manage.

Source: press release EAS April 24 2017