LAUSR

A recent study has shown that children with familial hypercholesterolaemia (FH) commenced on statin therapy have a 1% incidence of cardiovascular events, compared with 27% in their affected parents who were treated with statins later in life after a 20 year follow-up (Fig. 1). The investigation by Liurink et al. comes at apposite time when the value of statins in the primary prevention of coronary disease is again under scrutiny. Although not a prospective randomised trial, the data are unique and will have a significant impact on the management of patients with FH in a specific primary prevention setting. The study particularly highlighted that a lower potency statin (pravastatin), commenced during childhood, achieving a modest reduction in low-density lipoprotein (LDL)-cholesterol (32%) can very effectively prevent coronary events over 20 years. This underscores the value of earlier and sustained use of statin treatment without the requirements of the stringent LDL-cholesterol targets set for adults with FH in recent guidelines, a notion supported by Mendelian randomisation studies. References