1
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Bangash H, Saadatagah S, Naderian M, Hamed ME, Alhalabi L, Sherafati A, Sutton J, Elsekaily O, Mir A, Gundelach JH, Gibbons D, Johnsen P, Wood-Wentz CM, Smith CY, Caraballo PJ, Bailey KR, Kullo IJ. Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels. NPJ Digit Med 2024; 7:73. [PMID: 38499608 PMCID: PMC10948900 DOI: 10.1038/s41746-024-01069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before ('silent mode') and after ('active mode') its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, -10.7 to -2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41-2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06-1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.
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Affiliation(s)
- Hana Bangash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Marwan E Hamed
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lubna Alhalabi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alborz Sherafati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Sutton
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Omar Elsekaily
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ali Mir
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel Gibbons
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Paul Johnsen
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Pedro J Caraballo
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
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2
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Cuchel M, Lee PC, Hudgins LC, Duell PB, Ahmad Z, Baum SJ, Linton MF, de Ferranti SD, Ballantyne CM, Larry JA, Hemphill LC, Kindt I, Gidding SS, Martin SS, Moriarty PM, Thompson PP, Underberg JA, Guyton JR, Andersen RL, Whellan DJ, Benuck I, Kane JP, Myers K, Howard W, Staszak D, Jamison A, Card MC, Bourbon M, Chora JR, Rader DJ, Knowles JW, Wilemon K, McGowan MP. Contemporary Homozygous Familial Hypercholesterolemia in the United States: Insights From the CASCADE FH Registry. J Am Heart Assoc 2023; 12:e029175. [PMID: 37119068 PMCID: PMC10227232 DOI: 10.1161/jaha.122.029175] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
Background Homozygous familial hypercholesterolemia (HoFH) is a rare, treatment-resistant disorder characterized by early-onset atherosclerotic and aortic valvular cardiovascular disease if left untreated. Contemporary information on HoFH in the United States is lacking, and the extent of underdiagnosis and undertreatment is uncertain. Methods and Results Data were analyzed from 67 children and adults with clinically diagnosed HoFH from the CASCADE (Cascade Screening for Awareness and Detection) FH Registry. Genetic diagnosis was confirmed in 43 patients. We used the clinical characteristics of genetically confirmed patients with HoFH to query the Family Heart Database, a US anonymized payer health database, to estimate the number of patients with similar lipid profiles in a "real-world" setting. Untreated low-density lipoprotein cholesterol levels were lower in adults than children (533 versus 776 mg/dL; P=0.001). At enrollment, atherosclerotic cardiovascular disease and supravalvular and aortic valve stenosis were present in 78.4% and 43.8% and 25.5% and 18.8% of adults and children, respectively. At most recent follow-up, despite multiple lipid-lowering treatment, low-density lipoprotein cholesterol goals were achieved in only a minority of adults and children. Query of the Family Heart Database identified 277 individuals with profiles similar to patients with genetically confirmed HoFH. Advanced lipid-lowering treatments were prescribed for 18%; 40% were on no lipid-lowering treatment; atherosclerotic cardiovascular disease was reported in 20%; familial hypercholesterolemia diagnosis was uncommon. Conclusions Only patients with the most severe HoFH phenotypes are diagnosed early. HoFH remains challenging to treat. Results from the Family Heart Database indicate HoFH is systemically underdiagnosed and undertreated. Earlier screening, aggressive lipid-lowering treatments, and guideline implementation are required to reduce disease burden in HoFH.
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Affiliation(s)
- Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Paul C Lee
- Division of Translational Medicine and Human Genetics, Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Lisa C Hudgins
- The Rogosin Institute/Weill Cornell Medical College New York NY
| | - P Barton Duell
- Center for Preventive Cardiology, Knight Cardiovascular Institute, and Division of Endocrinology, Diabetes, and Clinical Nutrition, Department of Medicine Oregon Health and Science University Portland OR
| | - Zahid Ahmad
- Division of Endocrinology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | | | - MacRae F Linton
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN
| | | | | | - John A Larry
- Ohio State University Wexner Medical Center Columbus OH
| | | | | | | | - Seth S Martin
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | | | | | | | - John R Guyton
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine Duke University Medical Center Durham NC
| | | | | | - Irwin Benuck
- Department of Pediatrics Feinberg School of Medicine Chicago IL
| | | | | | | | | | | | | | - Mafalda Bourbon
- Unidade de I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa AND BioISI-Biosystems and Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa Lisboa Portugal
| | - Joana R Chora
- Unidade de I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa AND BioISI-Biosystems and Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa Lisboa Portugal
| | - Daniel J Rader
- Division of Translational Medicine and Human Genetics, Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Joshua W Knowles
- Family Heart Foundation Pasadena CA
- Division of Cardiovascular Medicine, Department of Medicine Cardiovascular Institute Stanford CA
- Stanford Diabetes Research Center Stanford CA
- Stanford Prevention Research Center Stanford CA
| | | | - Mary P McGowan
- Family Heart Foundation Pasadena CA
- Department of Medicine Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center Lebanon NH
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3
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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4
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Bassareo PP, O’Brien ST, Dunne E, Duignan S, Martino E, Martino F, Mcmahon CJ. Should We Be Screening for Ischaemic Heart Disease Earlier in Childhood? CHILDREN 2022; 9:children9070982. [PMID: 35883966 PMCID: PMC9320497 DOI: 10.3390/children9070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Ischaemic heart disease is the most common cause of death in males and the second in the female gender. Yet we often only focus on identification and treatment of this foremost cause of death in adulthood. The review asks the question what form of coronary disease do we encounter in childhood, what predisposing factors give rise to atherosclerosis and what strategies in childhood could we employ to detect and reduce atherosclerosis development in later life.
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Affiliation(s)
- Pier Paolo Bassareo
- Mater Misercordiae Hospital, Mater, D07 R2WY Dublin, Ireland
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland; (S.T.O.); (E.D.); (S.D.); (C.J.M.)
- School of Medicine, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Correspondence:
| | - Stephen T. O’Brien
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland; (S.T.O.); (E.D.); (S.D.); (C.J.M.)
| | - Esme Dunne
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland; (S.T.O.); (E.D.); (S.D.); (C.J.M.)
| | - Sophie Duignan
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland; (S.T.O.); (E.D.); (S.D.); (C.J.M.)
| | - Eliana Martino
- Department of Paediatrics, La Sapienza University, 00185 Roma, Italy; (E.M.); (F.M.)
| | - Francesco Martino
- Department of Paediatrics, La Sapienza University, 00185 Roma, Italy; (E.M.); (F.M.)
| | - Colin J. Mcmahon
- Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland; (S.T.O.); (E.D.); (S.D.); (C.J.M.)
- School of Medicine, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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5
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Familial Hypercholesterolemia (FH) Registry Worldwide: A Systematic Review. Curr Probl Cardiol 2021; 47:100999. [PMID: 34571102 DOI: 10.1016/j.cpcardiol.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022]
Abstract
Familial hypercholesterolemia (FH) is the most common genetic disease which accelerates the development of premature coronary artery disease (CAD) in young adults if remains untreated. The overall prevalence of FH is currently unknown and is usually underdiagnosed and undertreated worldwide. FH registry in different geographical area is a mission that helps early diagnosis of FH patients in the general population. PubMed, ISI Web of Science, Scopus, and Google Scholar were searched systematically for studies and reports on the FH registry using related keywords. Finally, 27 studies were included in this review. Most of the studies used the CASCADE screening method based on 1 or more than 1 of the 3 well-established FH criteria namely, the Dutch Lipid Clinic Network, Simon Broome Register, or Make Early Diagnosis to Prevent Early Death criteria. Except for a small number of studies that the genetic and molecular methods were used, in other studies only clinical diagnosis was applied. All these studies claimed that the FH registry causes the identification of many new cases as a result of used CASCADE screening and referral to lipid clinics. They concluded that the FH registry increases general and also physician awareness on FH prevalence and its related complications which in the long-term will improve FH management. This indicates that in other parts of the world, the FH registry should be established as well so that more accurate statistics on the prevalence of this disease can be found worldwide which would help in diagnosis and prevention.
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6
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Children with Heterozygous Familial Hypercholesterolemia in the United States: Data from the Cascade Screening for Awareness and Detection-FH Registry. J Pediatr 2021; 229:70-77. [PMID: 32976895 DOI: 10.1016/j.jpeds.2020.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/19/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe enrollment characteristics of youth in the Cascade Screening for Awareness and Detection of FH Registry. STUDY DESIGN This is a cross-sectional analysis of 493 participants aged <18 years with heterozygous familial hypercholesterolemia recruited from US lipid clinics (n = 20) between April 1, 2014, and January 12, 2018. At enrollment, some were new patients and some were already in care. Clinical characteristics are described, including lipid levels and lipid-lowering treatments. RESULTS Mean age at diagnosis was 9.4 (4.0) years; 47% female, 68% white and 12% Hispanic. Average (SD) highest Low-density lipoprotein cholesterol (LDL-C) was 238 (61) mg/dL before treatment. Lipid-lowering therapy was used by 64% of participants; 56% were treated with statin. LDL-C declined 84 mg/dL (33%) among those treated with lipid-lowering therapy; statins produced the greatest decline, 100 mg/dL (39% reduction). At enrollment, 39% had reached an LDL-C goal, either <130 mg/dL or ≥50% decrease from pre-treatment; 20% of those on lipid-lowering therapy reached both goals. CONCLUSIONS Among youth enrolled in the Cascade Screening for Awareness and Detection of FH Registry, diagnosis occurred relatively late, only 77% of children eligible for lipid-lowering therapy were receiving treatment, and only 39% of those treated met their LDL-C goal. Opportunities exist for earlier diagnosis, broader use of lipid-lowering therapy, and greater reduction of LDL-C levels.
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7
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Wilemon KA, Patel J, Aguilar-Salinas C, Ahmed CD, Alkhnifsawi M, Almahmeed W, Alonso R, Al-Rasadi K, Badimon L, Bernal LM, Bogsrud MP, Braun LT, Brunham L, Catapano AL, Cillíková K, Corral P, Cuevas R, Defesche JC, Descamps OS, de Ferranti S, Eiselé JL, Elikir G, Folco E, Freiberger T, Fuggetta F, Gaspar IM, Gesztes ÁG, Grošelj U, Hamilton-Craig I, Hanauer-Mader G, Harada-Shiba M, Hastings G, Hovingh GK, Izar MC, Jamison A, Karlsson GN, Kayikçioglu M, Koob S, Koseki M, Lane S, Lima-Martinez MM, López G, Martinez TL, Marais D, Marion L, Mata P, Maurina I, Maxwell D, Mehta R, Mensah GA, Miserez AR, Neely D, Nicholls SJ, Nohara A, Nordestgaard BG, Ose L, Pallidis A, Pang J, Payne J, Peterson AL, Popescu MP, Puri R, Ray KK, Reda A, Sampietro T, Santos RD, Schalkers I, Schreier L, Shapiro MD, Sijbrands E, Soffer D, Stefanutti C, Stoll M, Sy RG, Tamayo ML, Tilney MK, Tokgözoglu L, Tomlinson B, Vallejo-Vaz AJ, Vazquez-Cárdenas A, de Luca PV, Wald DS, Watts GF, Wenger NK, Wolf M, Wood D, Zegerius A, Gaziano TA, Gidding SS. Reducing the Clinical and Public Health Burden of Familial Hypercholesterolemia: A Global Call to Action. JAMA Cardiol 2021; 5:217-229. [PMID: 31895433 DOI: 10.1001/jamacardio.2019.5173] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH. Observations In 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created. Conclusions and Relevance By adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well.
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Affiliation(s)
| | | | - Jasmine Patel
- Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Carlos Aguilar-Salinas
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.,Departamaento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | | | - Mutaz Alkhnifsawi
- International Atherosclerosis Society, Milan, Italy.,Faculty of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Iraq
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Rodrigo Alonso
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,International Atherosclerosis Society, Milan, Italy.,Fundación Hipercolesterolemia Familiar, Madrid, Spain.,Nutrition Department, Clínica las Condes, Santiago de Chile, Chile
| | - Khalid Al-Rasadi
- International Atherosclerosis Society, Milan, Italy.,Medical Research Center, Sultan Qaboos University Hospital, Muscat, Oman
| | - Lina Badimon
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu I Sant Pau, CiberCV, Barcelona, Spain.,European Society of Cardiology, Biot, France
| | - Luz M Bernal
- Escuela de Ciencias de la Salud, Universidad Nacional Abierta y a Distancia, Bogotá, Colombia
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Lynne T Braun
- Department of Adult Health and Gerontological Nursing, Rush University, Chicago, Illinois
| | - Liam Brunham
- Centre for Heart Lung Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and MultiMedica Institute for Research, Hospitalization, and Health Care, Milano, Italy.,European Atherosclerosis Society, Göteborg, Sweden
| | | | - Pablo Corral
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,FASTA University School of Medicine, Mar del Plata, Argentina
| | | | - Joep C Defesche
- Department of Clinical Genetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Olivier S Descamps
- FH Europe, Europe.,Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium.,Belchol, Belgium
| | - Sarah de Ferranti
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Gerardo Elikir
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Sociedad Argentina de Lípidos, Cordoba, Argentina
| | - Emanuela Folco
- International Atherosclerosis Society, Milan, Italy.,Italian Heart Foundation-Fondazione Italiana Per il Cuore, Milan, Italy
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.,Central European Institute of Technology and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Francesco Fuggetta
- FH Europe, Europe.,Associazione Nazionale Ipercolesterolemia Familiare, Rome, Italy
| | - Isabel M Gaspar
- Lisbon Medical School, Centro Hospitalar de Lisboa Ocidental and Genetics Laboratory, Medical Genetics Department, University of Lisbon, Lisbon, Portugal
| | - Ákos G Gesztes
- FH Europe, Europe.,Szivesen Segitünk Neked, FH Hungary Patient Organisation, Budapest, Hungary
| | - Urh Grošelj
- University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Ian Hamilton-Craig
- Flinders University School of Medicine, Adelaide, South Australia, Australia
| | | | - Mariko Harada-Shiba
- National Cerebral and Cardiovascular Centre Research Institute, Suita, Osaka, Japan
| | - Gloria Hastings
- FH Europe, Europe.,Gruppo Italiano Pazienti-Familial Hypercholesterolemia, Milano, Italy
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maria C Izar
- Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Allison Jamison
- Familial Hypercholesterolemia Foundation, Pasadena, California
| | | | - Meral Kayikçioglu
- FH Europe, Europe.,Department of Cardiology, Medical Faculty, Ege University, Izmir, Turkey.,Ailevi Hiperkolesterolemi Derneği (Association of Familial Hypercholesterolemia), Bayraklı/İzmir, Turkey
| | - Sue Koob
- Preventive Cardiovascular Nurses Association, Madison, Wisconsin
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Stacey Lane
- Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Marcos M Lima-Martinez
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Department of Physiological Sciences, Universidad de Oriente, Ciudad Bolivar, Venezuela.,Endocrinology, Diabetes, Metabolism, and Nutrition Unit, Ciudad Bolivar, Venezuela
| | - Greizy López
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - David Marais
- Division of Chemical Pathology, Health Science Faculty, University of Cape Town, Cape Town, South Africa
| | - Letrillart Marion
- FH Europe, Europe.,Association Nationale des Hypercholestérolémies Familiales, Reims, France
| | - Pedro Mata
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Fundación Hipercolesterolemia Familiar, Madrid, Spain.,FH Europe, Europe
| | - Inese Maurina
- FH Europe, Europe.,ParSirdi.lv Patient Society, Riga, Latvia
| | | | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.,Departamaento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - André R Miserez
- Diagene Research Institute, Swiss FH Center, Reinach, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dermot Neely
- Department of Blood Sciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.,HEART UK, Berkshire, United Kingdom
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Atsushi Nohara
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leiv Ose
- Lipid Clinic, Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | - Athanasios Pallidis
- FH Europe, Europe.,Association of Familial Hypercholesterolemia, LDL Greece, Greece
| | - Jing Pang
- Faculty of Health and Medical Sciences, University of Western Australia School of Medicine, Perth, Western Australia, Australia
| | - Jules Payne
- FH Europe, Europe.,HEART UK, Berkshire, United Kingdom
| | - Amy L Peterson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Monica P Popescu
- FH Europe, Europe.,Fundația pentru Ocrotirea Bolnavilor cu Afectuni Cardiovasculare, Bucharest, Romania
| | - Raman Puri
- Department of Cardiology, Apollo Hospital, New Delhi, India.,Lipid Association of India, New Delhi, India
| | - Kausik K Ray
- European Atherosclerosis Society, Göteborg, Sweden.,Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College of London School of Public Health, London, United Kingdom
| | - Ashraf Reda
- Cardiology Department, Menofia University, Shibin Al Kawm, Al Minufiyah, Egypt.,Egyptian Association of Vascular Biology and Atherosclerosis, Cairo, Egypt
| | - Tiziana Sampietro
- Lipoapheresis Unit, Reference Center for Inherited Dyslipidemias, Fondazione CRN-Toscana Gabriele Monasterio, Pisa, Italy.,Italian Association of Inherited Dyslipidemias, Cascina Pisa, Italy
| | - Raul D Santos
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,International Atherosclerosis Society, Milan, Italy.,Lipid Clinic Heart Institute, Hospital Israelita Albert Einstein, University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Inge Schalkers
- FH Europe, Europe.,Harteraad, the Hague, the Netherlands
| | - Laura Schreier
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Laboratorio de Lípidos y Aterosclerosis, Departamento de Bioquímica Clínica, IndianaFIBIOC-UBA, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Michael D Shapiro
- Familial Hypercholesterolemia Foundation, Pasadena, California.,Section of Cardiovascular Medicine, Center for Preventive Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Eric Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Daniel Soffer
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Claudia Stefanutti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Extracorporeal Therapeutic Techniques Unit, Lipid Clinic, Regional Centre for Rare Metabolic Diseases, Umberto I Hospital, Rome, Italy
| | - Mario Stoll
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Honorary Commission for Cardiovascular Health, Montevideo, Uruguay
| | - Rody G Sy
- Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Martha L Tamayo
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Myra K Tilney
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Lipid Clinic, Mater Dei Hospital, Msida, Malta
| | - Lale Tokgözoglu
- European Atherosclerosis Society, Göteborg, Sweden.,Department of Cardiology of Cardiology, Hacettepe Univeristy, Ankara, Turkey
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College of London School of Public Health, London, United Kingdom
| | - Alejandra Vazquez-Cárdenas
- Familial Hypercholesterolemia IberoAmericana Network, Madrid, Spain.,Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México.,Associación Mexícana de Hipercolesterolemia Familiar, México
| | | | - David S Wald
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Gerald F Watts
- Faculty of Health and Medical Sciences, University of Western Australia School of Medicine, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nanette K Wenger
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michaela Wolf
- FASTA University School of Medicine, Mar del Plata, Argentina.,Patients' Organization for Patients with Familial Hypercholesterolaemia or Related Genetic Lipid Disorders, Frankfurt, Germany
| | - David Wood
- World Heart Federation, Geneva, Switzerland
| | - Aram Zegerius
- Individuals With Familial Hypercholesterolemia, the Hague, the Netherlands
| | - Thomas A Gaziano
- Sociedad Argentina de Lípidos, Cordoba, Argentina.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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8
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Gazzotti M, Casula M, Olmastroni E, Averna M, Arca M, Catapano AL. How registers could enhance knowledge and characterization of genetic dyslipidaemias: The experience of the LIPIGEN in Italy and of other networks for familial hypercholesterolemia. ATHEROSCLEROSIS SUPP 2020; 42:e35-e40. [PMID: 33589222 DOI: 10.1016/j.atherosclerosissup.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism, still underdiagnosed and undertreated in the general population. Pathology registers could play a crucial role in the creation of a comprehensive and integrated global approach to cover all aspects of this disease. Systematic data collection of patients affected by FH has increased dramatically worldwide in the past few years. Moreover, results from registers already established for the longest time showed their potentialities in the implementation of the knowledge of FH, comparing country-specific approaches and providing real-world data about identification, management and treatment of FH individuals in the clinical practice. The potential fields of research through registers are related to the deepening of the genetic basis of disease, the study of genotype-phenotype correlation, the local adaption and implementation of diagnostic algorithms, the comparison of pharmacological approaches and treatment gaps in real-life clinical practice, the evaluation of specific subpopulations, and the identification of factors modifying cardiovascular disease risk. Registers could become also a valid resource for other rare dyslipidaemias, contributing towards the evidence-based enhancement in the worldwide care of uncommon diseases.
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Affiliation(s)
- Marta Gazzotti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Maurizio Averna
- Department ProMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), University of Palermo, Palermo, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
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9
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Affiliation(s)
- Iftikhar J Kullo
- Department of Cardiovascular Medicine and the Gonda Vascular Center, Mayo Clinic, Rochester, MN
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10
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Vrablik M, Tichý L, Freiberger T, Blaha V, Satny M, Hubacek JA. Genetics of Familial Hypercholesterolemia: New Insights. Front Genet 2020; 11:574474. [PMID: 33133164 PMCID: PMC7575810 DOI: 10.3389/fgene.2020.574474] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Familial hypercholesterolemia (FH) is one of the most common monogenic diseases, leading to an increased risk of premature atherosclerosis and its cardiovascular complications due to its effect on plasma cholesterol levels. Variants of three genes (LDL-R, APOB and PCSK9) are the major causes of FH, but in some probands, the FH phenotype is associated with variants of other genes. Alternatively, the typical clinical picture of FH can result from the accumulation of common cholesterol-increasing alleles (polygenic FH). Although the Czech Republic is one of the most successful countries with respect to FH detection, approximately 80% of FH patients remain undiagnosed. The opportunities for international collaboration and experience sharing within international programs (e.g., EAS FHSC, ScreenPro FH, etc.) will improve the detection of FH patients in the future and enable even more accessible and accurate genetic diagnostics.
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Affiliation(s)
- Michal Vrablik
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Lukas Tichý
- Centre of Molecular Biology and Gene Therapy, University Hospital, Brno, Czechia
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Vladimir Blaha
- Internal Gerontometabolic Department, Charles University and University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | - Martin Satny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav A Hubacek
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czechia.,Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
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11
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Guo Q, Feng X, Zhou Y. PCSK9 Variants in Familial Hypercholesterolemia: A Comprehensive Synopsis. Front Genet 2020; 11:1020. [PMID: 33173529 PMCID: PMC7538608 DOI: 10.3389/fgene.2020.01020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023] Open
Abstract
Autosomal dominant familial hypercholesterolemia (FH) affects approximately 1/250, individuals and potentially leads to elevated blood cholesterol and a significantly increased risk of atherosclerosis. Along with improvements in detection and the increased early diagnosis and treatment, the serious burden of FH on families and society has become increasingly apparent. Since FH is strongly associated with proprotein convertase subtilisin/kexin type 9 (PCSK9), increasing numbers of studies have focused on finding effective diagnostic and therapeutic methods based on PCSK9. At present, as PCSK9 is one of the main pathogenic FH genes, its contribution to FH deserves more explorative research.
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Affiliation(s)
- Qianyun Guo
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Beijing Anzhen Hospital, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Xunxun Feng
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Beijing Anzhen Hospital, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Beijing Anzhen Hospital, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
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12
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Tada H, Okada H, Yoshida S, Shimojima M, Nomura A, Tsuda T, Mori M, Takashima SI, Kato T, Usui S, Sakata K, Hayashi K, Fujino N, Inazu A, Takahara S, Imai Y, Matsubara T, Nohara A, Miwa K, Namura M, Terai H, Yoshida T, Araki T, Minamoto M, Aburao T, Ito Y, Nakanishi C, Kawasaki S, Todo Y, Koizumi J, Kita Y, Matsumoto H, Shintaku H, Hodatsu A, Ino H, Higashikata T, Takata M, Misawa K, Yamaguchi M, Noji Y, Osato K, Mabuchi T, Ichise T, Kaku B, Katsuda S, Fujimoto M, Uchiyama K, Fujioka K, Nakahashi T, Nozue T, Michishita I, Usuda K, Otowa K, Okeie K, Hirota S, Aburadani I, Kurokawa K, Takatori O, Hondo S, Oda H, Takata S, Murai H, Kinoshita M, Nagai H, Sekiguchi Y, Sakagami S, Omi W, Fujita C, Katsuki T, Ootsuji H, Igarashi A, Nakano M, Okura S, Maeno K, Mitamura Y, Sugimoto N, Yamamoto M, Akao H, Kajinami K, Takamura M, Kawashiri MA. Hokuriku-plus familial hypercholesterolaemia registry study: rationale and study design. BMJ Open 2020; 10:e038623. [PMID: 32912992 PMCID: PMC7485236 DOI: 10.1136/bmjopen-2020-038623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Familial hypercholesterolaemia (FH) is an autosomal-dominant inherited genetic disease. It carries an extremely high cardiovascular risk associated with significantly elevated low-density lipoprotein (LDL) cholesterol. The diagnostic rate of this disease in some European nations is quite high, due to the presence of multiple prospective registries. On the other hand, few data-and in particular multicentre data-exist regarding this issue among Japanese subjects. Therefore, this study intends to assemble a multicentre registry that aims to comprehensively assess cardiovascular risk among Japanese FH patients while taking into account their genetic backgrounds. METHODS AND ANALYSIS The Hokuriku-plus FH registry is a prospective, observational, multicentre cohort study, enrolling consecutive FH patients who fulfil the clinical criteria of FH in Japan from 37 participating hospitals mostly in Hokuriku region of Japan from April 2020 to March 2024. A total of 1000 patients will be enrolled into the study, and we plan to follow-up participants over 5 years. We will collect clinical parameters, including lipids, physical findings, genetic backgrounds and clinical events covering atherosclerotic and other important events, such as malignancies. The primary endpoint of this study is new atherosclerotic cardiovascular disease (ASCVD) events. The secondary endpoints are as follows: LDL cholesterol, secondary ASCVD events and the occurrence of other diseases including hypertension, diabetes and malignancies. ETHICS AND DISSEMINATION This study is being conducted in compliance with the Declaration of Helsinki, the Ethical Guidelines for Medical and Health Research Involving Human Subjects, and all other applicable laws and guidelines in Japan. This study protocol has been approved by the Institutional Review Board at Kanazawa University. We will disseminate the final results at international conferences and in a peer-reviewed journal. TRIAL REGISTRATION NUMBER UMIN000038210.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaya Shimojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Toyonobu Tsuda
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Mika Mori
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shin-Ichiro Takashima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiro Inazu
- Department of Laboratory Science, Molecular Biochemistry and Molecular Biology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Shizuko Takahara
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Yasuhito Imai
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Takao Matsubara
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Atsushi Nohara
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenji Miwa
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Masanobu Namura
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Taiji Yoshida
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Tsutomu Araki
- Division of Internal Medicine, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Masahiro Minamoto
- Department of Internal Medicine, JCHO Kanazawa Hospital, Kanazawa, Japan
| | - Toru Aburao
- Department of Internal Medicine, JCHO Kanazawa Hospital, Kanazawa, Japan
| | - Yuji Ito
- Department of Internal Medicine, KKR Hokuriku Hospital, Kanazawa, Japan
| | - Chiaki Nakanishi
- Department of Internal Medicine, KKR Hokuriku Hospital, Kanazawa, Japan
| | - Suguru Kawasaki
- Department of Internal Medicine, Kanazawa-Nishi Hospital, Kanazawa, Japan
| | - Yasuhiro Todo
- Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers, Oyabe, Japan
| | - Junji Koizumi
- Department of Internal Medicine, Suzu City General Hospital, Suzu, Japan
| | - Yoshihito Kita
- Department of Internal Medicine, Wajima City Hospital, Wajima, Japan
| | - Hiroshi Matsumoto
- Department of Internal Medicine, Wajima City Hospital, Wajima, Japan
| | - Hiroaki Shintaku
- Department of Internal Medicine, Wajima City Hospital, Wajima, Japan
| | - Akihiko Hodatsu
- Department of Cardiology, Keiju General Hospital, Nanao, Japan
| | - Hidekazu Ino
- Department of Cardiology, Houju Memorial Hospital, Nomi, Japan
| | | | - Mutsuko Takata
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | - Katsushi Misawa
- Department of Internal Medicine, Kaga Medical Center, Kaga, Japan
| | - Masato Yamaguchi
- Department of Cardiology, Fukui Prefectural Hospital, Fukui, Japan
| | - Yoshihiro Noji
- Department of Cardiology, Fukui Prefectural Hospital, Fukui, Japan
| | - Kazuo Osato
- Department of Cardiology, Fukui CardioVascular Center, Fukui, Japan
| | - Tomohito Mabuchi
- Department of Cardiology, Fukui CardioVascular Center, Fukui, Japan
| | - Taro Ichise
- Department of Cardiology, Fukui CardioVascular Center, Fukui, Japan
| | - Bunji Kaku
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Shoji Katsuda
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Manabu Fujimoto
- Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan
| | | | - Kensuke Fujioka
- Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan
| | | | - Tsuyoshi Nozue
- Department of Cardiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Ichiro Michishita
- Department of Cardiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Kazuo Usuda
- Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kanichi Otowa
- Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazuyasu Okeie
- Department of Cardiology, Toyama City Hospital, Toyama, Japan
| | - Satoshi Hirota
- Department of Cardiology, Kurobe City Hospital, Kurobe, Japan
| | - Isao Aburadani
- Department of Cardiology, Kurobe City Hospital, Kurobe, Japan
| | - Keisuke Kurokawa
- Department of Cardiology, Tonami General Hospital, Tonami, Japan
| | - Osamu Takatori
- Department of Cardiology, Tonami General Hospital, Tonami, Japan
| | - Shunichiro Hondo
- Department of Cardiology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Hiroyuki Oda
- Department of Cardiology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Shigeo Takata
- Department of Cardiology, Kanazawa City Hospital, Kanazawa, Japan
| | - Hisayoshi Murai
- Department of Cardiology, Kanazawa City Hospital, Kanazawa, Japan
| | - Masaki Kinoshita
- Department of Cardiology, Kanazawa Arimatsu Hospital, Kanazawa, Japan
| | - Hideo Nagai
- Department of Cardiology, Kanazawa Red Cross Hospital, Kanazawa, Japan
| | | | - Satoru Sakagami
- Department of Cardiology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Wataru Omi
- Department of Cardiology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Chikara Fujita
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
| | - Tatsuo Katsuki
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
| | - Hiroshi Ootsuji
- Department of Internal Medicine, Hakui Public Hospital, Hakui, Japan
| | - Atsushi Igarashi
- Department of Internal Medicine, Hakui Public Hospital, Hakui, Japan
| | - Manabu Nakano
- Department of Internal Medicine, Noto General Hospital, Nanao, Japan
| | - Seiichiro Okura
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Koji Maeno
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Yasuhito Mitamura
- Department of Cardiology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Naoki Sugimoto
- Department of Internal Medicine, Tsurugi Hospital, Hakusan, Japan
| | - Masakazu Yamamoto
- Department of Cardiology, Kouseiren Namerikawa Hospital, Namerikawa, Japan
| | - Hironobu Akao
- Division of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Kouji Kajinami
- Division of Cardiology, Kanazawa Medical University Hospital, Kahoku-gun, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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13
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Balla S, Ekpo EP, Wilemon KA, Knowles JW, Rodriguez F. Women Living with Familial Hypercholesterolemia: Challenges and Considerations Surrounding Their Care. Curr Atheroscler Rep 2020; 22:60. [PMID: 32816232 DOI: 10.1007/s11883-020-00881-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To highlight the gender-based differences in presentation and disparities in care for women with familial hypercholesterolemia (FH). RECENT FINDINGS Women with FH experience specific barriers to care including underrepresentation in research, significant underappreciation of risk, and interrupted therapy during childbearing. National and international registry and clinical trial data show significant healthcare disparities for women with FH. Women with FH are less likely to be on guideline-recommended high-intensity statin medications and those placed on statins are more likely to discontinue them within their first year. Women with FH are also less likely to be on regimens including non-statin agents such as PCSK9 inhibitors. As a result, women with FH are less likely to achieve target low-density lipoprotein cholesterol (LDL-C) targets, even those with prior atherosclerotic cardiovascular disease (ASCVD). FH is common, under-diagnosed, and under-treated. Disparities of care are more pronounced in women than men. Additionally, FH weighs differently on women throughout the course of their lives starting from choosing contraceptives as young girls along with lipid-lowering therapy, timing pregnancy, choosing breastfeeding or resumption of therapy, and finally deciding goals of care during menopause. Early identification and appropriate treatment prior to interruptions of therapy for childbearing can lead to marked reduction in morbidity and mortality. Women access care differently than men and increasing awareness among all providers, especially cardio-obstetricians, may improve diagnostic rates. Understanding the unique challenges women with FH face is crucial to close the gaps in care they experience.
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Affiliation(s)
- Sujana Balla
- Division of Cardiovascular Medicine & Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, University of California San Francisco Fresno, Fresno, CA, USA
| | - Eson P Ekpo
- Division of Cardiovascular Medicine & Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Joshua W Knowles
- The FH Foundation, Pasadena, CA, USA. .,Stanford Department of Medicine, Diabetes Research Center, Cardiovascular Institute, Stanford, CA, USA. .,Cardiovascular Medicine, Stanford University, Falk CVRC, Room CV273, MC 5406 300 Pasteur Drive, Stanford, CA, 94305, USA.
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine & Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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14
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Mszar R, Buscher S, Taylor HL, Rice-DeFosse MT, McCann D. Familial Hypercholesterolemia and the Founder Effect Among Franco-Americans: A Brief History and Call to Action. CJC Open 2020; 2:161-167. [PMID: 32462130 PMCID: PMC7242505 DOI: 10.1016/j.cjco.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 01/01/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an inherited disorder characterized by chronically elevated low-density lipoprotein cholesterol levels and an increased risk of premature atherosclerotic cardiovascular disease. FH has been shown to disproportionately affect French Canadians and other ethnic populations due to the presence of a founder effect characterized by reduced genetic diversity resulting from relatively few individuals with FH-causing genetic mutations establishing self-contained populations. Beginning in the mid-1800s, approximately 1 million French Canadians immigrated to the Northeastern United States and largely remained in these small, tight-knit communities. Despite extensive genetic- and population-based research involving the French-Canadian founder population, primarily in the Province of Quebec, little is known regarding Franco-Americans in the United States. Concurrent with addressing the underdiagnosis rate of FH in the general population, we propose the following steps to leverage this founder effect and meet the cardiovascular needs of Franco-Americans: (1) increase cascade screening in regions of the United States with a high proportion of individuals of French-Canadian descent; (2) promote registry-based, epidemiological research to elucidate accurate prevalence estimates as well as diagnostic and treatment gaps in Franco-Americans; and (3) validate contemporary risk stratification strategies such as the Montreal-FH-SCORE to enable optimal lipid management and prevention of premature atherosclerotic cardiovascular disease among French-Canadian descendants.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sara Buscher
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Heidi L. Taylor
- Department of Sociology, Bates College, Lewiston, Maine, USA
| | - Mary T. Rice-DeFosse
- Department of French and Francophone Studies, Bates College, Lewiston, Maine, USA
| | - Dervilla McCann
- Department of Cardiology, Central Maine Medical Center, Lewiston, Maine, USA
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15
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McGowan MP, Hosseini Dehkordi SH, Moriarty PM, Duell PB. Diagnosis and Treatment of Heterozygous Familial Hypercholesterolemia. J Am Heart Assoc 2019; 8:e013225. [PMID: 31838973 PMCID: PMC6951065 DOI: 10.1161/jaha.119.013225] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | - P. Barton Duell
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandOR
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16
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Longitudinal low density lipoprotein cholesterol goal achievement and cardiovascular outcomes among adult patients with familial hypercholesterolemia: The CASCADE FH registry. Atherosclerosis 2019; 289:85-93. [DOI: 10.1016/j.atherosclerosis.2019.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/31/2019] [Accepted: 08/16/2019] [Indexed: 02/02/2023]
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17
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Myers KD, Farboodi N, Mwamburi M, Howard W, Staszak D, Gidding S, Baum SJ, Wilemon K, Rader DJ. Effect of Access to Prescribed PCSK9 Inhibitors on Cardiovascular Outcomes. Circ Cardiovasc Qual Outcomes 2019; 12:e005404. [PMID: 31331194 PMCID: PMC7665275 DOI: 10.1161/circoutcomes.118.005404] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Atherosclerotic cardiovascular disease remains a major cause of death and disability, especially for high-risk familial hypercholesterolemia individuals. PCSK9i (proprotein convertase subtilisin kexin type 9 inhibitors) reduce low-density lipoprotein cholesterol levels and cardiovascular event rates. However, PCSK9i prescriptions are rejected at high rates by payers, and use is often delayed or eventually abandoned as a treatment option. We tested the hypothesis that acute coronary syndromes, coronary interventions, stroke, and cardiac arrest are more prevalent in patients with rejected or abandoned PCSK9i prescriptions than for those with paid PCSK9i prescriptions.
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Affiliation(s)
- Kelly D Myers
- The FH Foundation, Pasadena, CA (K.D.M., N.F., S.G., K.W.).,Atomo, Inc, Austin, TX (K.D.M., W.H., D.S.)
| | | | | | | | | | - Samuel Gidding
- The FH Foundation, Pasadena, CA (K.D.M., N.F., S.G., K.W.)
| | - Seth J Baum
- Preventive Cardiology, Inc, Boca Raton, FL (S.J.B.)
| | | | - Daniel J Rader
- Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.)
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18
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Ahmad F, McNally EM, Ackerman MJ, Baty LC, Day SM, Kullo IJ, Madueme PC, Maron MS, Martinez MW, Salberg L, Taylor MR, Wilcox JE. Establishment of Specialized Clinical Cardiovascular Genetics Programs: Recognizing the Need and Meeting Standards: A Scientific Statement From the American Heart Association. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e000054. [DOI: 10.1161/hcg.0000000000000054] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular genetics is a rapidly evolving subspecialty within cardiovascular medicine, and its growth is attributed to advances in genome sequencing and genetic testing and the expanding understanding of the genetic basis of multiple cardiac conditions, including arrhythmias (channelopathies), heart failure (cardiomyopathies), lipid disorders, cardiac complications of neuromuscular conditions, and vascular disease, including aortopathies. There have also been great advances in clinical diagnostic methods, as well as in therapies to ameliorate symptoms, slow progression of disease, and mitigate the risk of adverse outcomes. Emerging challenges include interpretation of genetic test results and the evaluation, counseling, and management of genetically at-risk family members who have inherited pathogenic variants but do not yet manifest disease. With these advances and challenges, there is a need for specialized programs combining both cardiovascular medicine and genetics expertise. The integration of clinical cardiovascular findings, including those obtained from physical examination, imaging, and functional assessment, with genetic information allows for improved diagnosis, prognostication, and cascade family testing to identify and to manage risk, and in some cases to provide genotype-specific therapy. This emerging subspecialty may ultimately require a new cardiovascular subspecialist, the genetic cardiologist, equipped with these combined skills, to permit interpretation of genetic variation within the context of phenotype and to extend the utility of genetic testing. This scientific statement outlines current best practices for delivering cardiovascular genetic evaluation and care in both the pediatric and the adult settings, with a focus on team member expertise and conditions that most benefit from genetic evaluation.
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Chen P, Chen X, Zhang S. Current Status of Familial Hypercholesterolemia in China: A Need for Patient FH Registry Systems. Front Physiol 2019; 10:280. [PMID: 30949068 PMCID: PMC6435575 DOI: 10.3389/fphys.2019.00280] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/04/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Familial hypercholesterolemia (FH) greatly facilitates the development of cardiovascular disease (CVD). Without timely treatment, the incidence of coronary heart disease (CHD) in patients with FH is 3 to 4 times that in non-FH patients, and the onset of CVD would be advanced by approximately 10 years. There is ample evidence that the diagnosis and adequate treatment of FH are not properly considered for all ethnicities. The monogenic cause of FH includes apolipoprotein B (APOB), low-density lipoprotein receptor (LDLR), and proprotein convertase subtilisin/kexin 9 (PCSK9). There are approximately 2,765,420 to 6,913,550 cases of potential heterozygous FH (HeFH) and 2,205 to 4,609 cases of potential homozygous FH (HoFH) in China. Nevertheless, China lacks clinical diagnostic criteria specific to Chinese patients, such that most FH patients cannot be diagnosed until middle age or after their first cardiovascular event, thus precluding early treatment. Objective: This article explores the gene mutations, diagnosis and treatment of FH patients in China. Following the implementation of the two-child policy, there is a need to establish Chinese FH registry systems and genetic databases and to address the challenges in conducting cascade screening and long-term management. Conclusion: Advocating the establishment of FH registry systems and databases is an important rate-limiting step in improving long-term prognosis in FH patients, so that joint efforts of clinical experts and public communities are required. We recommend a process flow from case identification to entry into the registry system, and the widespread use of the system in clinical applications can provide the best treatment guidance for medical practice.
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Affiliation(s)
| | | | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Brett T, Qureshi N, Gidding S, Watts GF. Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part. Atherosclerosis 2018; 277:399-406. [DOI: 10.1016/j.atherosclerosis.2018.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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21
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Mehta R, Martagon AJ, Galan Ramirez GA, Gonzalez Retana G, Martinez-Beltran M, Vargas Vazquez A, Vazquez-Cardenas A, Aguilar-Salinas CA. The development of the Mexican Familial Hypercholesterolemia (FH) National Registry. Atherosclerosis 2018; 277:517-523. [DOI: 10.1016/j.atherosclerosis.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/03/2018] [Accepted: 06/07/2018] [Indexed: 11/15/2022]
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Ungar L, Sanders D, Becerra B, Barseghian A. Percutaneous Coronary Intervention in Familial Hypercholesterolemia Is Understudied. Front Cardiovasc Med 2018; 5:116. [PMID: 30214904 PMCID: PMC6125301 DOI: 10.3389/fcvm.2018.00116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a common heritable condition in which mutations of genes governing cholesterol metabolism result in elevated LDL levels and accelerated atherosclerosis. The treatment of FH focuses on lipid lowering drugs to decrease patients' cholesterol levels and reduce their risk of cardiovascular events. Even with optimal medical therapy, some FH patients will develop coronary atherosclerosis, suffer myocardial infarction, and require revascularization. Yet, the revascularization of FH patients has not been widely studied. Here we review FH, identify unanswered questions in the interventional management of FH patients, and explore barriers and opportunities for answering these questions. Further research is needed in this neglected but important topic in interventional cardiology.
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Affiliation(s)
- Leo Ungar
- Department of Cardiology, University of California, Irvine, Irvine, CA, United States
| | - David Sanders
- Department of Internal Medicine, University of California, Irvine, Irvine, CA, United States
| | - Brian Becerra
- Department of Internal Medicine, University of California, Irvine, Irvine, CA, United States
| | - Ailin Barseghian
- Department of Cardiology, University of California, Irvine, Irvine, CA, United States
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23
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Radaelli G, Sausen G, Cesa CC, Portal VL, Pellanda LC. Secondary Dyslipidemia In Obese Children - Is There Evidence For Pharmacological Treatment? Arq Bras Cardiol 2018; 111:356-361. [PMID: 30156604 PMCID: PMC6173338 DOI: 10.5935/abc.20180155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Long-term safety, effectiveness and criteria for treatment with statins in children are still unclear in clinical practice. There is very limited evidence for the use of medication to treat children with dyslipidemia secondary to obesity who do not respond well to lifestyle modification. OBJECTIVE Systematic review of randomized clinical trials of statin use to treat children and adolescents with dyslipidemia secondary to obesity. METHODS We performed a search in PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO, and LILACS for data to evaluate the effect of statins on: improvement of surrogate markers of coronary artery disease in clinical outcomes of adulthood; increased serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipropotein B (APOB); and decreased serum levels of high-density lipoprotein cholesterol (HDL-C) from inception to February 2016. Participants were children and adolescents. RESULTS Of the 16793 potentially relevant citations recovered from the electronic databases, no randomized clinical trials fulfilled the inclusion criteria for children with dyslipidemia secondary to obesity. CONCLUSIONS We found no specific evidence to consider statins in the treatment of hypercholesterolemia secondary to obesity in children. The usual practice of extrapolating findings from studies in genetic dyslipidemia ignores the differences in long-term cardiovascular risks and the long-term drug treatment risks, when compared to recommendation of lifestyle changes. Randomized clinical trials are needed to understand drug treatment in dyslipidemia secondary to obesity.
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Affiliation(s)
- Graciane Radaelli
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Grasiele Sausen
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Claudia Ciceri Cesa
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Vera Lucia Portal
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Lucia Campos Pellanda
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
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24
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Wurtmann E, Steinberger J, Veach PM, Khan M, Zierhut H. Risk Communication in Families of Children with Familial Hypercholesterolemia: Identifying Motivators and Barriers to Cascade Screening to Improve Diagnosis at a Single Medical Center. J Genet Couns 2018; 28:10.1007/s10897-018-0290-0. [PMID: 30109451 DOI: 10.1007/s10897-018-0290-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
Familial hypercholesterolemia (FH) is severely underdiagnosed in the USA; yet, factors influencing family notification about risk for FH in the US pediatric setting have not been well elucidated. Most previous research on these factors has occurred in adult patient populations in European countries with organized cascade screening programs; therefore, we sought to characterize parent experiences with cascade screening in the US pediatric setting. A quantitative survey measuring family notification of FH risk information was administered to 38 parents of children with FH identified within a pediatric cardiology clinic. Participants were also asked if family notification was impacted by intrapersonal, interpersonal, institutional, community, and public policy factors identified previously in other populations. Notification of at least one of the proband's living grandparents or aunts/uncles was reported by 76% (n = 25/33) and 71% (n = 24/34) of participants, respectively. The most common reason for notification was to protect relatives from heart disease. Two of the most common reasons participants did not notify relatives were a lack of information about FH and concern that the relative would have difficulty understanding the information. Yet, only a minority of participants (39%) accessed institutional resources such as educational materials to share with relatives or assistance drafting a family letter that could address these barriers. Based on the identified barriers and motivators for family communication, we suggest facilitators to improve implementation of cascade screening.
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Affiliation(s)
- Elisabeth Wurtmann
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Julia Steinberger
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Pat McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Mindi Khan
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA.
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26
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Familial Screening for Left-Sided Congenital Heart Disease: What Is the Evidence? What Is the Cost? Diseases 2017; 5:diseases5040029. [PMID: 29292713 PMCID: PMC5750540 DOI: 10.3390/diseases5040029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022] Open
Abstract
Since the American Heart Association’s recommendation for familial screening of adults with congenital heart disease for bicuspid aortic valve, similar recommendations for other left-sided heart defects, such as hypoplastic left heart syndrome (HLHS), have been proposed. However, defining at-risk populations for these heart defects based on genetics is less straightforward due to the wide variability of inheritance patterns and non-genetic influences such as environmental and lifestyle factors. We discuss whether there is sufficient evidence to standardize echocardiographic screening for first-degree relatives of children diagnosed with HLHS. Due to variations in the inclusion of cardiac anomalies linked to HLHS and the identification of asymptomatic individuals with cardiac malformations, published studies are open to interpretation. We conclude that familial aggregation of obstructive left-sided congenital heart lesions in families with history of HLHS is not supported and recommend that additional screening should adopt a more conservative definition of what truly constitutes this heart defect. More thorough consideration is needed before embracing familial screening recommendations of families of patients with HLHS, since this could inflict serious costs on healthcare infrastructure and further burden affected families both emotionally and financially.
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27
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Health disparities among adult patients with a phenotypic diagnosis of familial hypercholesterolemia in the CASCADE-FH™ patient registry. Atherosclerosis 2017; 267:19-26. [DOI: 10.1016/j.atherosclerosis.2017.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 11/24/2022]
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Abdul-Razak S, Rahmat R, Mohd Kasim A, Rahman TA, Muid S, Nasir NM, Ibrahim Z, Kasim S, Ismail Z, Abdul Ghani R, Sanusi AR, Rosman A, Nawawi H. Diagnostic performance of various familial hypercholesterolaemia diagnostic criteria compared to Dutch lipid clinic criteria in an Asian population. BMC Cardiovasc Disord 2017; 17:264. [PMID: 29037163 PMCID: PMC5644062 DOI: 10.1186/s12872-017-0694-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 10/06/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is a genetic disorder with a high risk of developing premature coronary artery disease that should be diagnosed as early as possible. Several clinical diagnostic criteria for FH are available, with the Dutch Lipid Clinic Criteria (DLCC) being widely used. Information regarding diagnostic performances of the other criteria against the DLCC is scarce. We aimed to examine the diagnostic performance of the Simon-Broom (SB) Register criteria, the US Make Early Diagnosis to Prevent Early Deaths (US MEDPED) and the Japanese FH Management Criteria (JFHMC) compared to the DLCC. METHODS Seven hundered fifty five individuals from specialist clinics and community health screenings with LDL-c level ≥ 4.0 mmol/L were selected and diagnosed as FH using the DLCC, the SB Register criteria, the US MEDPED and the JFHMC. The sensitivity, specificity, efficiency, positive and negative predictive values of individuals screened with the SB register criteria, US MEDPED and JFHMC were assessed against the DLCC. RESULTS We found the SB register criteria identified more individuals with FH compared to the US MEDPED and the JFHMC (212 vs. 105 vs. 195; p < 0.001) when assessed against the DLCC. The SB Register criteria, the US MEDPED and the JFHMC had low sensitivity (51.1% vs. 25.3% vs. 47.0% respectively). The SB Register criteria showed better diagnostic performance than the other criteria with 98.8% specificity, 28.6% efficiency value, 98.1% and 62.3% for positive and negative predictive values respectively. CONCLUSION The SB Register criteria appears to be more useful in identifying positive cases leading to genetic testing compared to the JFHMC and US MEDPED in this Asian population. However, further research looking into a suitable diagnosis criterion with high likelihood of positive genetic findings is required in the Asian population including in Malaysia.
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Affiliation(s)
- Suraya Abdul-Razak
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Primary Care Medicine Discipline, Faculty of Medicine, University Teknologi MARA, 68100 Selayang, Selangor Malaysia
| | - Radzi Rahmat
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Alicezah Mohd Kasim
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Thuhairah Abdul Rahman
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Suhaila Muid
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Nadzimah Mohd Nasir
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Zubin Ibrahim
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Cardiology Unit, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Sazzli Kasim
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Cardiology Unit, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Zaliha Ismail
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Population Health and Preventive Medicine Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
| | - Rohana Abdul Ghani
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Endocrinology Disciplines, Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor Malaysia
| | - Abdul Rais Sanusi
- National Heart Institute, No 145 Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - Azhari Rosman
- National Heart Institute, No 145 Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - Hapizah Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
- Pathology Discipline, Faculty of Medicine, University Teknologi MARA, 47000 Sungai Buloh, Selangor Malaysia
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Martin AC, Bell DA, Brett T, Watts GF. Beyond cascade screening: detection of familial hypercholesterolaemia at childhood immunization and other strategies. Curr Opin Lipidol 2017; 28:321-327. [PMID: 28426524 DOI: 10.1097/mol.0000000000000423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolaemia is a common genetic disorder that accelerates premature coronary heart disease. Although effective treatments are available, the majority of individuals remain undiagnosed. We review new evidence for improving the detection of familial hypercholesterolaemia. RECENT FINDINGS Recent studies have demonstrated that universal screening of children for familial hypercholesterolaemia may be highly effective at the time of immunization if combined with reverse cascade testing of adult family members, who have a more immediate risk of a coronary event. Alerts on laboratory reports and the application of bioinformatics to electronic health records may also be useful for identifying familial hypercholesterolaemia in community settings. Effective detection, diagnosis, and codification of familial hypercholesterolaemia are essential for the development of registries. SUMMARY Although the cost-effectiveness of screening programs for familial hypercholesterolaemia in childhood remains to be established, combining universal and reverse cascade screening, complemented by opportunistic identification of individuals in high-risk settings, use of laboratory alerts, and screening of electronic health records are likely to have a high yield in the detection of familial hypercholesterolaemia in the community.
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Affiliation(s)
- Andrew C Martin
- aDepartment of General Paediatrics, Princess Margaret Hospital for Children bSchool of Paediatrics and Child Health cFaculty of Health and Medical Sciences, School of Medicine, University of Western Australia dLipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth eGeneral Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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30
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Martin AC, Gidding SS, Wiegman A, Watts GF. Knowns and unknowns in the care of pediatric familial hypercholesterolemia. J Lipid Res 2017; 58:1765-1776. [PMID: 28701353 DOI: 10.1194/jlr.s074039] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 07/10/2017] [Indexed: 12/18/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common genetic disorder that causes elevated LDL cholesterol levels from birth. Untreated FH accelerates atherosclerosis and predisposes individuals to premature coronary artery disease (CAD) in adulthood. Mendelian randomization studies have demonstrated that LDL cholesterol has both a causal and cumulative effect on the risk of CAD. This supports clinical recommendations that children with FH commence pharmacological treatment from the age of 8 to 10 years, to reduce the burden of hypercholesterolemia. Worldwide, the majority of children with FH remain undiagnosed. Recent evidence suggests that the frequency of FH is at least 1 in 250 and this constitutes a public health issue. We review and identify the knowns and unknowns concerning the detection and management of pediatric FH that impact on the developing model of care for this condition.
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Affiliation(s)
- Andrew C Martin
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Samuel S Gidding
- Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE
| | - Albert Wiegman
- Department of Paediatrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerald F Watts
- Lipid Disorders Clinic, School of Medicine, University of Western Australia, Perth, Western Australia, Australia and Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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VRABLÍK M, VACLOVÁ M, TICHÝ L, SOŠKA V, BLÁHA V, FAJKUSOVÁ L, ČEŠKA R, ŠATNÝ M, FREIBERGER T. Familial Hypercholesterolemia in the Czech Republic: More Than 17 Years of Systematic Screening Within the MedPed Project. Physiol Res 2017; 66:S1-S9. [DOI: 10.33549/physiolres.933600] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Familial hypercholesterolemia (FH) is the most common autosomal dominant disorder. It is characterized by a decrease in LDL cholesterol catabolism and an early clinical manifestation of atherosclerotic vessel damage. The aim of the MedPed (Make early diagnosis to Prevent early deaths) project is an early diagnosis of FH patients in order to profit from early treatment and prevent cardiovascular events. Till November 30, 2016 The Czech National MedPed Database has registered 7,001 FH patients from 5,223 different families that is 17.4 % of expected patients in the Czech Republic considering 1:250 FH prevalence. The improvement in diagnostic accuracy, patient cooperation and above all familial cascade screening is enabled by FH mutation detection using the modern technology of next-generation sequencing. FH still remain undiagnosed even though the Czech Republic is one of the most successful countries with respect to FH detection. The opportunities of international collaboration and experience sharing within international programs (e.g. EAS FHSC, ScreenPro FH etc.) will improve the detection of FH patients in the future and enable even more accessible and accurate genetic diagnostics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - T. FREIBERGER
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
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Minicocci I, Pozzessere S, Prisco C, Montali A, di Costanzo A, Martino E, Martino F, Arca M. Analysis of Children and Adolescents with Familial Hypercholesterolemia. J Pediatr 2017; 183:100-107.e3. [PMID: 28161202 DOI: 10.1016/j.jpeds.2016.12.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/28/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of criteria based on child-parent assessment in predicting familial hypercholesterolemia (FH)-causative mutations in unselected children with hypercholesterolemia. STUDY DESIGN LDLR, APOB, and PCSK9 genes were sequenced in 78 children and adolescents (mean age 8.4 ± 3.7 years) with clinically diagnosed FH. The presence of polygenic hypercholesterolemia was further evaluated by genotyping 6 low-density lipoprotein cholesterol (LDL-C)-raising single-nucleotide polymorphisms. RESULTS Thirty-nine children (50.0%) were found to carry LDLR mutant alleles but none with APOB or PCSK9 mutant alleles. Overall, 27 different LDLR mutations were identified, and 2 were novel. Children carrying mutations showed higher LDL-C (215.2 ± 52.7 mg/dL vs 181.0 ± 44.6 mg/dL, P <.001) and apolipoprotein B levels (131.6 ± 38.3 mg/dL vs 100.3 ± 30.0 mg/dL, P <.004), compared with noncarriers. A LDL-C of ~190 mg/dL was the optimal value to discriminate children with and without LDLR mutations. When different diagnostic criteria were compared, those proposed by the European Atherosclerosis Society showed a reasonable balance between sensitivity and specificity in the identification of LDLR mutations. In children without mutation, the FH phenotype was not caused by the aggregation of LDL-C raising single-nucleotide polymorphisms. CONCLUSIONS In unselected children with hypercholesterolemia, LDL-C levels >190 mg/dL and a positive family history of hypercholesterolemia appeared to be the most reliable criteria for detecting FH. As 50% of children with suspected FH did not carry FH-causing mutations, genetic testing should be considered.
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Affiliation(s)
- Ilenia Minicocci
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy
| | - Simone Pozzessere
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Prisco
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy
| | - Anna Montali
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessia di Costanzo
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy
| | - Eliana Martino
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Marcello Arca
- Department of Internal Medicine and Allied Sciences, Sapienza University of Rome, Rome, Italy.
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Bellgard MI, Walker CE, Napier KR, Lamont L, Hunter AA, Render L, Radochonski M, Pang J, Pedrotti A, Sullivan DR, Kostner K, Bishop W, George PM, O'Brien RC, Clifton PM, Bockxmeer FMV, Nicholls SJ, Hamilton-Craig I, Dawkins HJ, Watts GF. Design of the Familial Hypercholesterolaemia Australasia Network Registry: Creating Opportunities for Greater International Collaboration. J Atheroscler Thromb 2017; 24:1075-1084. [PMID: 28344196 PMCID: PMC5656770 DOI: 10.5551/jat.37507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Familial Hypercholesterolemia (FH) is the most common and serious monogenic disorder of lipoprotein metabolism that leads to premature coronary heart disease. There are over 65,000 people estimated to have FH in Australia, but many remain undiagnosed. Patients with FH are often undertreated, but with early detection, cascade family testing and adequate treatment, patient outcomes can improve. Patient registries are key tools for providing new information on FH and enhancing care worldwide. The development and design of the FH Australasia Network Registry is a crucial component in the comprehensive model of care for FH, which aims to provide a standardized, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. Informed by stakeholder engagement, the FH Australasia Network Registry was collaboratively developed by government, patient and clinical networks and research groups. The open-source, webbased Rare Disease Registry Framework was the architecture chosen for this registry owing to its open-source standards, modular design, interoperability, scalability and security features; all these are key components required to meet the ever changing clinical demands across regions. This paper provides a high level blueprint for other countries and jurisdictions to help inform and map out the critical features of an FH registry to meet their particular health system needs.
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Affiliation(s)
| | - Caroline E Walker
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia
| | | | - Leanne Lamont
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia
| | - Adam A Hunter
- Centre for Comparative Genomics, Murdoch University, Murdoch
| | - Lee Render
- Centre for Comparative Genomics, Murdoch University, Murdoch
| | | | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia
| | - Annette Pedrotti
- Familial Hypercholesterolaemia Family Support Group of Western Australia
| | | | | | - Warrick Bishop
- Menzies Institute for Medical Research, University of Tasmania
| | | | | | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia
| | - Frank M Van Bockxmeer
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital.,School of Surgery, University of Western Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide
| | | | - Hugh Js Dawkins
- Centre for Comparative Genomics, Murdoch University, Murdoch.,Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia.,Centre for Population Health Research, Curtin University of Technology.,School of Pathology and Laboratory Medicine, University of Western Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital
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Mehta R, Zubirán R, Martagón AJ, Vazquez-Cárdenas A, Segura-Kato Y, Tusié-Luna MT, Aguilar-Salinas CA. The panorama of familial hypercholesterolemia in Latin America: a systematic review. J Lipid Res 2016; 57:2115-2129. [PMID: 27777316 PMCID: PMC5321217 DOI: 10.1194/jlr.r072231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/23/2016] [Indexed: 11/20/2022] Open
Abstract
The burden caused by familial hypercholesterolemia (FH) varies among countries and ethnic groups. The prevalence and characteristics of FH in Latin American (LA) countries is largely unknown. We present a systematic review (following the PRISMA statement) of FH in LA countries. The epidemiology, genetics, screening, management, and unique challenges encountered in these countries are discussed. Published reports discussing FH in Hispanic or LA groups was considered for analysis. Thirty studies were included representing 10 countries. The bulk of the data was generated in Brazil and Mexico. Few countries have registries and there was little commonality in FH mutations between LA countries. LDL receptor mutations predominate; APOB and PCSK9 mutations are rare. No mutation was found in an FH gene in nearly 50% of cases. In addition, some country-specific mutations have been reported. Scant information exists regarding models of care, cascade screening, cost, treatment effectiveness, morbidity, and mortality. In conclusion, FH is largely underdiagnosed and undertreated in the LA region. The genetic admixture with indigenous populations, producing mestizo's groups, may influence the mutational findings in Latin America. Potential opportunities to close gaps in knowledge and health care are identified.
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Affiliation(s)
- Roopa Mehta
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rafael Zubirán
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | - Yayoi Segura-Kato
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico; Unidad de Biología Molecular y Medicina Genómica Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Teresa Tusié-Luna
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico; Unidad de Biología Molecular y Medicina Genómica Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
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Ellis KL, Pang J, Watts GF. Registries, codifications and cardiovascular outcomes in familial hypercholesterolaemia. Eur J Prev Cardiol 2016; 24:133-136. [DOI: 10.1177/2047487316680696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Katrina L Ellis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Jing Pang
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Australia
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Statins in the Management of Pediatric Dyslipidemia. J Pediatr Nurs 2016; 31:723-735. [PMID: 27496827 DOI: 10.1016/j.pedn.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/10/2016] [Accepted: 07/10/2016] [Indexed: 01/23/2023]
Abstract
Hypercholesterolemia is a major concern in the USA, with studies identifying children as young as 2years old with early-stage atherosclerosis. Genetics play a major role in the dyslipidemia of children, but other factors, such as diet and lack of physical activity, confound the problem. Familial hypercholesterolemia (FH) is a genetic condition that causes lifelong elevations in low-density lipoprotein cholesterol (LDL-C). The heterozygous form of the disease affects around 1 in 200 people, and the homozygous form of the disease affects around 1 in 160,000-300,000 people. Early identification and appropriate management of patients with FH are essential to reduce cardiovascular disease morbidity and mortality. Consequently, US dyslipidemia guidelines recommend routine screening of all children aged 9-11years, and that LDL-C levels should be <110mg/dL in children and adolescents. The primary management strategy in all children with dyslipidemia is diet and lifestyle; a healthy diet (including fruits, vegetables, fish, and whole grains) and increased physical activity should be encouraged. Most patients with FH will also require pharmacotherapy to reduce LDL-C levels to ≤130mg/dL. Statins are recommended as first-line therapy due to their proven efficacy in reducing LDL-C and improving other lipid parameters in children. They have also been shown to have a positive effect on atherosclerosis. Safety is of particular concern with children; however, studies have so far shown that the side-effect profile of statins in children is similar to that in adults. Despite improvements in disease management, FH remains underdiagnosed and undertreated, highlighting the need for greater awareness and understanding.
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Statin-associated muscle symptoms and SLCO1B1 rs4149056 genotype in patients with familial hypercholesterolemia. Am Heart J 2016; 179:1-9. [PMID: 27595674 DOI: 10.1016/j.ahj.2016.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/09/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Patients with familial hypercholesterolemia (FH) may be at increased risk for statin-associated muscle symptoms because they require long-term treatment with high-intensity statin therapy. We sought to determine (1) whether other predisposing factors, including the well-known genetic variant associated with statin-associated muscle symptoms-solute carrier organic anion transporter family, member 1B1 (SLCO1B1) rs4149056-also increase the risk of statin-associated muscle symptoms in FH patients, and (2) the natural history and management for FH patients with statin-associated muscle symptoms. METHODS We queried electronic records (2004-2014) of 278 genetically screened FH patients (113 men, 165 women; mean [SD] pretreatment low-density lipoprotein cholesterol [LDL-C] 259 [72] mg/dL) recruited from lipid clinics in the Dallas, TX, area from 2004 to 2014. Statin-associated muscle symptoms were defined as muscle symptoms arising while taking a statin and interrupting therapy. RESULTS The risk of muscle symptoms was associated with age (odds ratio 1.6 [95% CI 1.2-2.2]), body mass index in non-African Americans (0.90 [0.83-0.97]), and hypertension (0.4 [0.2-0.9]). Simvastatin was the most commonly used statin, and it was the statin most associated with muscle symptoms. Among FH patients with muscle symptoms, 41% (n = 40) reestablished statin therapy ("eventually tolerant") and 29% (n = 28) never reestablished statin therapy ("never tolerant"). Rosuvastatin (43%) and pravastatin (30%) were the most common eventually tolerated statins, and eventually tolerant patients achieved lower treated LDL-C levels (eventually tolerant 127 vs never tolerant 192 mg/dL, P < .001). Never tolerant patients also developed muscle symptoms on nonstatins (16% vs 50%, P = .003). SLCO1B1 rs4149056 genotyping revealed 224 wild-type patients (TT) and 49 heterozygotes (TC). SLCO1B1 genotype was not associated with the risk of statin-associated muscle symptoms (odds ratio 1.40 [95% CI 0.74-2.64]). CONCLUSION Age, not SLCO1B1 rs4149056 genotype, was the strongest risk factor for statin-associated muscle symptoms in FH patients. After developing muscle symptoms, many patients reestablished statin therapy and achieved significant LDL-C reductions. Overall, 10% of all FH patients had statin-associated muscle symptoms and never reestablished statin therapy. Such patients developed muscle symptoms even on nonstatin lipid-lowering drugs and continued to have elevations in LDL-C. Further insight is needed into the relationship between FH and statin-associated muscle symptoms so all FH patients can be adequately treated.
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Affiliation(s)
- Anne C Goldberg
- From Washington University School of Medicine, St. Louis, MO (A.C.G.); and A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.)
| | - Samuel S Gidding
- From Washington University School of Medicine, St. Louis, MO (A.C.G.); and A. I. DuPont Hospital for Children, Wilmington, DE (S.S.G.).
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Safarova MS, Liu H, Kullo IJ. Rapid identification of familial hypercholesterolemia from electronic health records: The SEARCH study. J Clin Lipidol 2016; 10:1230-9. [PMID: 27678441 DOI: 10.1016/j.jacl.2016.08.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about prevalence, awareness, and control of familial hypercholesterolemia (FH) in the United States. OBJECTIVE To address these knowledge gaps, we developed an ePhenotyping algorithm for rapid identification of FH in electronic health records (EHRs) and deployed it in the Screening Employees And Residents in the Community for Hypercholesterolemia (SEARCH) study. METHODS We queried a database of 131,000 individuals seen between 1993 and 2014 in primary care practice to identify 5992 (mean age 52 ± 13 years, 42% men) patients with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, triglycerides <400 mg/dL and without secondary causes of hyperlipidemia. RESULTS Our EHR-based algorithm ascertained the Dutch Lipid Clinic Network criteria for FH using structured data sets and natural language processing for family history and presence of FH stigmata on physical examination. Blinded expert review revealed positive and negative predictive values for the SEARCH algorithm at 94% and 97%, respectively. The algorithm identified 32 definite and 391 probable cases with an overall FH prevalence of 0.32% (1:310). Only 55% of the FH cases had a diagnosis code relevant to FH. Mean LDL-C at the time of FH ascertainment was 237 mg/dL; at follow-up, 70% (298 of 423) of patients were on lipid-lowering treatment with 80% achieving an LDL-C ≤100 mg/dL. Of treated FH patients with premature CHD, only 22% (48 of 221) achieved an LDL-C ≤70 mg/dL. CONCLUSIONS In a primary care setting, we found the prevalence of FH to be 1:310 with low awareness and control. Further studies are needed to assess whether automated detection of FH in EHR improves patient outcomes.
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Affiliation(s)
- Maya S Safarova
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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US physician practices for diagnosing familial hypercholesterolemia: data from the CASCADE-FH registry. J Clin Lipidol 2016; 10:1223-9. [PMID: 27678440 DOI: 10.1016/j.jacl.2016.07.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the US familial hypercholesterolemia (FH), patients are underidentified, despite an estimated prevalence of 1:200 to 1:500. Criteria to identify FH patients include Simon Broome, Dutch Lipid Clinic Network (DLCN), or Make Early Diagnosis to Prevent Early Deaths (MEDPED). The use of these criteria in US clinical practices remains unclear. OBJECTIVE To characterize the FH diagnostic criteria applied by US lipid specialists participating in the FH Foundation's CASCADE FH (CAscade SCreening for Awareness and DEtection of Familial Hypercholesterolemia) patient registry. METHODS We performed an observational, cross-sectional analysis of diagnostic criteria chosen for each adult patient, both overall and by baseline patient characteristics, at 15 clinical sites that had contributed data to the registry as of September 8, 2015. A sample of 1867 FH adults was analyzed. The median age at FH diagnosis was 50 years, and the median pretreatment low-density lipoprotein cholesterol (LDL-C) value was 238 mg/dL. The main outcome was the diagnostic criteria chosen. Diagnostic criteria were divided into five nonexclusive categories: "clinical diagnosis," MEDPED, Simon Broome, DLCN, and other. RESULTS Most adults enrolled in CASCADE FH (55.0%) received a "clinical diagnosis." The most commonly used formal criteria was Simon-Broome only (21%), followed by multiple diagnostic criteria (16%), MEDPED only (7%), DLCN only (1%), and other (0.5%), P < .0001. Of the patients with only a "clinical diagnosis," 93% would have met criteria for Simon Broome, DLCN, or MEDPED based on the data available in the registry. CONCLUSIONS Our findings demonstrate heterogeneity in the application of FH diagnostic criteria in the United States. A nationwide consensus definition may lead to better identification, earlier treatment, and ultimately CHD prevention.
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Gidding SS. Familial Hypercholesterolemia: Now Part of Cardiovascular Disease Genetic Epidemiology Research. J Am Coll Cardiol 2016; 67:2590-2. [PMID: 27256830 DOI: 10.1016/j.jacc.2016.03.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/22/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Samuel S Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, Delaware.
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Safarova MS, Kullo IJ. My Approach to the Patient With Familial Hypercholesterolemia. Mayo Clin Proc 2016; 91:770-86. [PMID: 27261867 PMCID: PMC5374743 DOI: 10.1016/j.mayocp.2016.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/18/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
Abstract
Familial hypercholesterolemia (FH), a relatively common Mendelian genetic disorder, is associated with a dramatically increased lifetime risk of premature atherosclerotic cardiovascular disease due to elevated plasma low-density lipoprotein cholesterol (LDL-C) levels. The diagnosis of FH is based on clinical presentation or genetic testing. Early identification of patients with FH is of great public health importance because preventive strategies can lower the absolute lifetime cardiovascular risk and screening can detect affected relatives. However, low awareness, detection, and control of FH pose hurdles in the prevention of FH-related cardiovascular events. Of the estimated 0.65 million to 1 million patients with FH in the United States, less than 10% carry a diagnosis of FH. Based on registry data, a substantial proportion of patients with FH are receiving no or inadequate lipid-lowering therapy. Statins remain the mainstay of treatment for patients with FH. Lipoprotein apheresis and newly approved lipid-lowering drugs are valuable adjuncts to statin therapy, particularly when the LDL-C-lowering response is suboptimal. Monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 provide an additional approximately 60% lowering of LDL-C levels and are approved for use in patients with FH. For homozygous FH, 2 new drugs that work independent of the LDL receptor pathway are available: an apolipoprotein B antisense oligonucleotide (mipomersen) and a microsomal triglyceride transfer protein inhibitor (lomitapide). This review attempts to critically examine the available data to provide a summary of the current evidence for managing patients with FH, including screening, diagnosis, treatment, and surveillance.
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Affiliation(s)
- Maya S Safarova
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN.
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Genetic diagnosis of familial hypercholesterolemia in Han Chinese. J Clin Lipidol 2016; 10:490-6. [DOI: 10.1016/j.jacl.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 12/26/2022]
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Davis T, Andersen R, Andersen L, Testa H, Ibarra J. Combined Cascade Screening And Patient Education For Familial Hypercholesterolemia: Genetic Results From A Family Shared Medical Appointment Pilot Study. J Clin Lipidol 2016. [DOI: 10.1016/j.jacl.2016.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiang L, Sun LY, Pan XD, Chen PP, Tang L, Wang W, Zhao LM, Yang SW, Wang LY. Characterization of the unique Chinese W483X mutation in the low-density lipoprotein–receptor gene in young patients with homozygous familial hypercholesterolemia. J Clin Lipidol 2016; 10:538-546.e5. [DOI: 10.1016/j.jacl.2015.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/05/2015] [Accepted: 12/16/2015] [Indexed: 12/22/2022]
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Henderson R, O'Kane M, McGilligan V, Watterson S. The genetics and screening of familial hypercholesterolaemia. J Biomed Sci 2016; 23:39. [PMID: 27084339 PMCID: PMC4833930 DOI: 10.1186/s12929-016-0256-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/03/2016] [Indexed: 11/14/2022] Open
Abstract
Familial Hypercholesterolaemia is an autosomal, dominant genetic disorder that leads to elevated blood cholesterol and a dramatically increased risk of atherosclerosis. It is perceived as a rare condition. However it affects 1 in 250 of the population globally, making it an important public health concern. In communities with founder effects, higher disease prevalences are observed. We discuss the genetic basis of familial hypercholesterolaemia, examining the distribution of variants known to be associated with the condition across the exons of the genes LDLR, ApoB, PCSK9 and LDLRAP1. We also discuss screening programmes for familial hypercholesterolaemia and their cost-effectiveness. Diagnosis typically occurs using one of the Dutch Lipid Clinic Network (DCLN), Simon Broome Register (SBR) or Make Early Diagnosis to Prevent Early Death (MEDPED) criteria, each of which requires a different set of patient data. New cases can be identified by screening the family members of an index case that has been identified as a result of referral to a lipid clinic in a process called cascade screening. Alternatively, universal screening may be used whereby a population is systematically screened. It is currently significantly more cost effective to identify familial hypercholesterolaemia cases through cascade screening than universal screening. However, the cost of sequencing patient DNA has fallen dramatically in recent years and if the rate of progress continues, this may change.
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Affiliation(s)
- Raymond Henderson
- Northern Ireland Centre for Stratified Medicine, Ulster University, C-TRIC, Altnagelvin Hospital Campus, Derry, Co Londonderry, Northern Ireland, BT47 6SB, UK
| | - Maurice O'Kane
- Department of Clinical Chemistry, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, Northern Ireland, BT47 6SB, UK
| | - Victoria McGilligan
- Northern Ireland Centre for Stratified Medicine, Ulster University, C-TRIC, Altnagelvin Hospital Campus, Derry, Co Londonderry, Northern Ireland, BT47 6SB, UK
| | - Steven Watterson
- Northern Ireland Centre for Stratified Medicine, Ulster University, C-TRIC, Altnagelvin Hospital Campus, Derry, Co Londonderry, Northern Ireland, BT47 6SB, UK.
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deGoma EM, Ahmad ZS, O'Brien EC, Kindt I, Shrader P, Newman CB, Pokharel Y, Baum SJ, Hemphill LC, Hudgins LC, Ahmed CD, Gidding SS, Duffy D, Neal W, Wilemon K, Roe MT, Rader DJ, Ballantyne CM, Linton MF, Duell PB, Shapiro MD, Moriarty PM, Knowles JW. Treatment Gaps in Adults With Heterozygous Familial Hypercholesterolemia in the United States: Data From the CASCADE-FH Registry. ACTA ACUST UNITED AC 2016; 9:240-9. [PMID: 27013694 DOI: 10.1161/circgenetics.116.001381] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease burden and treatment patterns among patients with familial hypercholesterolemia (FH) in the United States remain poorly described. In 2013, the FH Foundation launched the Cascade Screening for Awareness and Detection (CASCADE) of FH Registry to address this knowledge gap. METHODS AND RESULTS We conducted a cross-sectional analysis of 1295 adults with heterozygous FH enrolled in the CASCADE-FH Registry from 11 US lipid clinics. Median age at initiation of lipid-lowering therapy was 39 years, and median age at FH diagnosis was 47 years. Prevalent coronary heart disease was reported in 36% of patients, and 61% exhibited 1 or more modifiable risk factors. Median untreated low-density lipoprotein cholesterol (LDL-C) was 239 mg/dL. At enrollment, median LDL-C was 141 mg/dL; 42% of patients were taking high-intensity statin therapy and 45% received >1 LDL-lowering medication. Among FH patients receiving LDL-lowering medication(s), 25% achieved an LDL-C <100 mg/dL and 41% achieved a ≥50% LDL-C reduction. Factors associated with prevalent coronary heart disease included diabetes mellitus (adjusted odds ratio 1.74; 95% confidence interval 1.08-2.82) and hypertension (2.48; 1.92-3.21). Factors associated with a ≥50% LDL-C reduction from untreated levels included high-intensity statin use (7.33; 1.86-28.86) and use of >1 LDL-lowering medication (1.80; 1.34-2.41). CONCLUSIONS FH patients in the CASCADE-FH Registry are diagnosed late in life and often do not achieve adequate LDL-C lowering, despite a high prevalence of coronary heart disease and risk factors. These findings highlight the need for earlier diagnosis of FH and initiation of lipid-lowering therapy, more consistent use of guideline-recommended LDL-lowering therapy, and comprehensive management of traditional coronary heart disease risk factors.
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Affiliation(s)
- Emil M deGoma
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Zahid S Ahmad
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Emily C O'Brien
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Iris Kindt
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Peter Shrader
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Connie B Newman
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Yashashwi Pokharel
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Seth J Baum
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Linda C Hemphill
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Lisa C Hudgins
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Catherine D Ahmed
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Samuel S Gidding
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Danielle Duffy
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - William Neal
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Katherine Wilemon
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Matthew T Roe
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Daniel J Rader
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Christie M Ballantyne
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - MacRae F Linton
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - P Barton Duell
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Michael D Shapiro
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Patrick M Moriarty
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Joshua W Knowles
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.).
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Blom DJ, Fayad ZA, Kastelein JJ, Larrey D, Makris L, Schwamlein C, Bloeden L, Underberg J. LOWER, a registry of lomitapide-treated patients with homozygous familial hypercholesterolemia: Rationale and design. J Clin Lipidol 2016; 10:273-82. [DOI: 10.1016/j.jacl.2015.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/09/2015] [Accepted: 11/22/2015] [Indexed: 12/11/2022]
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Improving the Monitoring and Care of Patients With Familial Hypercholesterolemia ∗. J Am Coll Cardiol 2016; 67:1286-8. [DOI: 10.1016/j.jacc.2016.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/21/2022]
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Andersen R, Andersen L. Examining barriers to cascade screening for familial hypercholesterolemia in the United States. J Clin Lipidol 2016; 10:225-7. [DOI: 10.1016/j.jacl.2015.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/03/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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