Drug Treatment of FH in Adults
ÎFor adult FH patients, initial treatment is the use of moderate to high doses of high-potency statins (rosuvastatin, atorvastatin, simvastatin) titrated to achieve an LDL-C reduction ≥ 50% from baseline. Low potency statins are generally inadequate for FH patients.
ÎIf the initial statin is not tolerated, consider changing to an alternative statin or every other day statin therapy.
ÎIf initial statin therapy is contraindicated or poorly tolerated, ezetimibe, a bile acid sequestrant (colesevelam), or niacin may be considered.
ÎFor patients who cannot use a statin, most will require combination drug therapy.
Intensified Drug Treatment
ÎHigher-risk patients may need intensification of drug treatment to achieve more aggressive treatment goals (LDL-C < 100 mg/dL and non–HDL-C < 130 mg/dL).
ÎAny of the following places FH patients at higher CHD risk:
• Diabetes • Current smoking • Clinically evident CHD or other atherosclerotic cardiovascular disease • A family history of very early CHD (in men < 45 years of age and women < 55 years of age)
• Two or more CHD risk factors • High lipoprotein (a) ≥ 50 mg/dL using an isoform insensitive assay
ÎIn FH patients without any of the characteristics listed above, intensification of drug therapy may be considered if LDL-C remains ≥ 160 mg/dL (or non–HDL-C ≥ 190 mg/dL), or if an initial 50% reduction in LDL-C is not achieved.
ÎEzetimibe, niacin, and bile acid sequestrants are reasonable treatment options for intensification of therapy or for those intolerant of statins.
ÎThe potential benefit of multidrug regimens for an individual patient should be weighed against the increased cost and potential for adverse effects and decreased adherence.
