The principal implication of the FNLA’s first recommendation is that physicians should understand that basically all FH patients will require consideration for a life-long treatment plan. Probably the most compelling evidence for this assertion comes from the Dutch Lipid Clinic Network,[5] which has done a very good job in The Netherlands of finding both individuals with FH and their relatives and treating them with effective drug treatment strategies for >20 years. In the Figure that the top blue line represents the event-free survival of individuals who have received long-term statin therapy; the lower, dashed red line are the event-free survival rates in those individuals in the pre- statin therapy era of this registry who were not prescribed a statin. The immediate and large divergence of the 2 curves shows unequivocally that the patients in the “placebo” group, ie, these historically untreated FH patients, had very high event rates and a very low level of event-free survival, even over a relatively short period of 12 years. Since the time when these data were collected it has become clear that it is not ethical to withhold efficacious treatment (ie, statins, in this case) from people with FH, and therefore the best available evidence is really only this quite robust observational data, demonstrating that
[5]Versmissen J, Oosterveer DM, Yazdanpanah M, et al. Efficacy of statins in familial hypercholesterolaemia: A long-term cohort study. BMJ 2008; 337: a2423.
