Long-term outcomes of coronary artery bypass grafting in patients with familial hypercholesterolemia

This systematic review aimed to evaluate long-term outcomes after CABG in patients with FH and to identify major determinants of prognosis. A systematic literature search was performed in PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library following PRISMA guidelines. Among 139 identified records, 17 studies met inclusion criteria and provided data on surgical revascularization in heterozygous and homozygous FH. Historical cohorts (Takahashi, Kawasuji and colleagues) demonstrated that the use of internal thoracic artery grafts combined with aggressive lipid lowering—including LDL apheresis—provides 10–18-year survival rates of 80–90%, with most late adverse events related to vein-graft atherosclerosis. Contemporary registries (Béliard, Iyen, HELLAS-FH) indicate that failure to achieve LDL-C targets substantially increases residual cardiovascular risk, while diabetes and socioeconomic deprivation further worsen outcomes. Modern CABG cohorts (Deconinck et al.) show that FH is associated with more than a twofold increase in MACE risk when preoperative lipid control is suboptimal. Long-term CABG outcomes in FH can be favorable when arterial conduits are used and strict LDL-C targets are achieved. Prognosis is driven not only by coronary anatomy but also by the quality of secondary prevention, accessibility of lipid-lowering therapy, and comorbid conditions. Further research is needed in the contemporary era of PCSK9 inhibitors and lipoprotein apheresis.