ArticleThe Lancet regional health. Europe2026
Lipid-Lowering Treatment in Familial Hypercholesterolaemia, 1996-2021: A Nationwide Study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In familial hypercholesterolaemia, early and intensive lipid-lowering treatment postpones coronary heart disease and death, effectively shown after introduction of statins and later ezetimibe and PCSK9 inhibitors. However, whether use of lipid-lowering treatment has improved in females and males with familial hypercholesterolaemia over time remains somewhat unclear. In this nationwide study, we tested the hypothesis that lipid-lowering treatment in familial hypercholesterolaemia improved from 1996 through 2021. Methods: In a nationwide study of 7,976,375 individuals aged 0-113 in Denmark, all with a diagnosis of familial hypercholesterolaemia from 1996 to 2021 were included. Temporal trends in lipid-lowering medication were described by sex and coronary heart disease. Findings: For females and males with familial hypercholesterolaemia, treatment with lipid-lowering medications increased from 1996 to about 2008 after which little change was seen. In females, any medical treatment increased from 76% (99/130) in 1996 to 86% (879/1027) in 2021 in those with coronary heart disease and from 52% (115/222) to 78% (2716/3462) in those without. Corresponding values for males were 67% (134/199)-90% (1006/1117) and 48% (105/219)-80% (1421/1772). In females with coronary heart disease, use of lipid-lowering combination therapy increased from 16% (21/130) in 1996 to 34% (345/1027) in 2021, high-intensity statin from 0% (0/88) to 41% (331/809), and lipid-lowering therapy initiation within one year of diagnosis from 45% (5/11) to 92% (343/374). Corresponding values for males were from 18% (35/199) to 50% (553/1117), from 0.8% (1/121) to 60% (570/946), and from 77% (23/30) to 92% (275/299). Similar trends were seen for individuals without coronary heart disease, however, with lower percentages. Interpretation: Nationwide in Denmark from 1996 through 2021, lipid-lowering medication use improved in those with familial hypercholesterolaemia irrespective of sex and coronary heart disease status. Funding: The Johan and Lise Boserup Foundation; The Independent Research Fund Denmark; and Copenhagen University Hospital-Herlev Gentofte, Denmark.
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