Robinson - Figure 7 - Recommendation #3 Text

The third recommendation from the FNLA committee concentrates on selected higher risk FH patients, people with additional risk factors, for whom intensification of drug therapy is recommended, with consideration of trying to achieve an LDL goal of <100 mg/dL or a non-HDL (total cholesterol minus the HDL cholesterol level, in mg/dL) goal of <130 mg/dL. This can be accomplished with intensification of drug therapy, via up-titration of statin dosage and/or additional non-statin cholesterol-lowering therapies. Patients in whom consideration of therapy intensification should be pursued include

• FH patients who already have clinical atherosclerosis, clinical CHD, or stroke;
• FH patients who have concomitant diabetes;
• FH patients with a family history of very early onset CHD, in a father before age 45 or a mother before age 55 years;
• FH patients those who are smokers or who have ≥2 cardiovascular risk factors.

All of these FH patients are at very high risk and should be considered as candidates for intensification of therapy to a more aggressive LDL lowering goal of <100 mg/ dL. In particular, physicians should think of FH patients who smoke as being like pouring gasoline on the fire. FH patients who smoke are advancing the risk of their first myocardial infarction (MI) 10 or 15 years, and the presentation of that first MI is often death – so for these people, smoking cessation is a matter of life and death.

Robinson J. J Clin Lipidol. 2011; 5(6).