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Wang C, Yu P, Hu L, Liang M, Mao Y, Zeng Q, Wang X, Huang K, Yan J, Xie L, Zhang F, Zhu F. Prevalence and prognosis of molecularly defined familial hypercholesterolemia in patients with acute coronary syndrome. Front Cardiovasc Med 2022; 9:921803. [PMID: 35966514 PMCID: PMC9363594 DOI: 10.3389/fcvm.2022.921803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Familial hypercholesterolemia (FH) can elevate serum low-density lipoprotein cholesterol (LDL-C) levels, which can promote the progression of acute coronary syndrome (ACS). However, the effect of FH on the prognosis of ACS remains unclear. Methods In this prospective cohort study, 223 patients with ACS having LDL-C ≥ 135.3 mg/dL (3.5 mmol/L) were enrolled and screened for FH using a multiple-gene FH panel. The diagnosis of FH was defined according to the ACMG/AMP criteria as carrying pathogenic or likely pathogenic variants. The clinical features of FH and the relationship of FH to the average 16.6-month risk of cardiovascular events (CVEs) were assessed. Results The prevalence of molecularly defined FH in enrolled patients was 26.9%, and coronary artery lesions were more severe in patients with FH than in those without (Gensini score 66.0 vs. 28.0, respectively; P < 0.001). After lipid lowering, patients with FH still had significantly higher LDL-C levels at their last visit (73.5 ± 25.9 mg/dL vs. 84.7 ± 37.1 mg/dL; P = 0.013) compared with those without. FH increased the incidence of CVEs in patients with ACS [hazard ratio (HR): 3.058; 95% confidence interval (CI): 1.585–5.900; log-rank P < 0.001]. Conclusion FH is associated with an increased risk of CVEs in ACS and is an independent risk factor for ACS. This study highlights the importance of genetic testing of FH-related gene mutations in patients with ACS.
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Affiliation(s)
- Cheng Wang
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Puliang Yu
- Wuhan University of Science and Technology, Wuhan, China
| | - Lizhi Hu
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Minglu Liang
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Mao
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qiutang Zeng
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Huang
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Yan
- Department of Clinical Laboratory, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiao Zhang
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Fengxiao Zhang,
| | - Feng Zhu
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Feng Zhu
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2
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Hauguel-Moreau M, Aïdan V, Hergault H, Beauchet A, Pépin M, Prati G, Pillière R, Ouadahi M, Josseran L, Rodon C, Rabès JP, Charron P, Dubourg O, Massy Z, Mansencal N. Prevalence of familial hypercholesterolaemia in patients presenting with premature acute coronary syndrome. Arch Cardiovasc Dis 2022; 115:87-95. [DOI: 10.1016/j.acvd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/02/2022]
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3
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Peng JJ, Saleh N, Roston TM, Kramer A, Cermakova L, Mancini GJ, Fordyce CB, Brunham LR. The design and rationale of the Advancing Cardiac Care Unit-based Rapid Assessment and Treatment of hypErcholesterolemia (ACCURATE) study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100097. [PMID: 38560068 PMCID: PMC10978219 DOI: 10.1016/j.ahjo.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 04/04/2024]
Abstract
Familial hypercholesterolemia (FH) is an inherited condition characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease (ASCVD). Despite being the most common inherited cardiovascular disorder, it is still highly underdiagnosed and undertreated worldwide. We designed the Advancing Cardiac Care Unit-based Rapid Assessment and Treatment of hypErcholesterolemia (ACCURATE) study to test the hypothesis that opportunistic genetic testing for FH among patients hospitalized for acute coronary syndrome (ACS) will increase the diagnosis of FH and improve patient outcomes. ACCURATE is a non-randomized, controlled trial of patients <60 years old admitted to an acute cardiac unit with ACS and elevated LDL-C levels. The first cohort will consist of a control group of patients presenting with ACS who will be treated according to usual standard-of-care. The second cohort will consist of patients presenting with ACS in whom research-based genetic testing for FH will be performed during hospitalization and the results returned to the treating physicians. The primary endpoint will be the number of patients with a new diagnosis of FH. The secondary endpoints will be the proportion of patients who undergo intensification of lipid-lowering therapy, the lowest LDL-C level achieved, and the proportion of patients reaching guideline recommended lipid targets in the 12 months after the index ACS. To our knowledge, ACCURATE represents the first clinical trial of genetic testing for FH in the acute cardiac care setting and is expected to help identify optimal approaches to increase the diagnosis and treatment of FH.
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Affiliation(s)
- Junran J. Peng
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Navid Saleh
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas M. Roston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam Kramer
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lubomira Cermakova
- Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Vancouver, Canada
| | - G.B. John Mancini
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christopher B. Fordyce
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Liam R. Brunham
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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4
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Benedek P, Jiao H, Duvefelt K, Skoog T, Linde M, Kiviluoma P, Kere J, Eriksson M, Angelin B. Founder effects facilitate the use of a genotyping-based approach to molecular diagnosis in Swedish patients with familial hypercholesterolaemia. J Intern Med 2021; 290:404-415. [PMID: 33955087 DOI: 10.1111/joim.13287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022]
Abstract
AIM To investigate whether genotyping could be used as a cost-effective screening step, preceding next-generation sequencing (NGS), in molecular diagnosis of familial hypercholesterolaemia (FH) in Swedish patients. METHODS AND RESULTS Three hundred patients of Swedish origin with clinical suspicion of heterozygous FH were analysed using a specific array genotyping panel embedding 112 FH-causing mutations in the LDLR, APOB and PCSK9 genes. The mutations had been selected from previous reports on FH patients in Scandinavia and Finland. Mutation-negative cases were further analysed by NGS. In 181 patients with probable or definite FH using the Dutch lipid clinics network (DLCN) criteria (score ≥ 6), a causative mutation was identified in 116 (64%). Of these, 94 (81%) were detected by genotyping. Ten mutations accounted for more than 50% of the positive cases, with APOB c.10580G>A being the most common. Mutations in LDLR predominated, with (c.2311+1_2312-1)(2514)del (FH Helsinki) and c.259T>G having the highest frequency. Two novel LDLR mutations were identified. In patients with DLCN score < 6, mutation detection rate was significantly higher at younger age. CONCLUSION A limited number of mutations explain a major fraction of FH cases in Sweden. Combination of selective genotyping and NGS facilitates the clinical challenge of cost-effective genetic screening in suspected FH. The frequency of APOB c.10580G>A was higher than previously reported in Sweden. The lack of demonstrable mutations in the LDLR, APOB and PCSK9 genes in ~1/3 of patients with probable FH strongly suggests that additional genetic mechanisms are to be found in phenotypic FH.
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Affiliation(s)
- P Benedek
- From the, Cardiometabolic Unit, Clinical Department of Endocrinology, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.,Department of Medicine, Integrated Cardiometabolic Center (ICMC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
| | - H Jiao
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - K Duvefelt
- Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - T Skoog
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - M Linde
- Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - P Kiviluoma
- Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - J Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden.,Folkhälsan Research Center, Helsinki, Finland.,Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - M Eriksson
- From the, Cardiometabolic Unit, Clinical Department of Endocrinology, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.,Clinical Research Center, Karolinska University Hospital, Huddinge, Sweden
| | - B Angelin
- From the, Cardiometabolic Unit, Clinical Department of Endocrinology, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden.,Department of Medicine, Integrated Cardiometabolic Center (ICMC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
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5
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Gallo A, Charriere S, Vimont A, Chapman MJ, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrié A, Bruckert E, Béliard S, Angoulvant D, Beliard S, Boccara F, Bruckert E, Cariou B, Carreau V, Carrie A, Charriere S, Cottin Y, Filippo MDI, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, Giral P, Gonbert S, Hankard R, Inamo J, Kalmykova O, Krempf M, Moulin P, Paillard F, Peretti N, Perrin A, Pierre Rabes J, Sultan A, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O. SAFEHEART risk-equation and cholesterol-year-score are powerful predictors of cardiovascular events in French patients with familial hypercholesterolemia. Atherosclerosis 2020; 306:41-49. [DOI: 10.1016/j.atherosclerosis.2020.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023]
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6
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Hu P, Dharmayat KI, Stevens CA, Sharabiani MT, Jones RS, Watts GF, Genest J, Ray KK, Vallejo-Vaz AJ. Prevalence of Familial Hypercholesterolemia Among the General Population and Patients With Atherosclerotic Cardiovascular Disease. Circulation 2020; 141:1742-1759. [DOI: 10.1161/circulationaha.119.044795] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
Contemporary studies suggest that familial hypercholesterolemia (FH) is more frequent than previously reported and increasingly recognized as affecting individuals of all ethnicities and across many regions of the world. Precise estimation of its global prevalence and prevalence across World Health Organization regions is needed to inform policies aiming at early detection and atherosclerotic cardiovascular disease (ASCVD) prevention. The present study aims to provide a comprehensive assessment and more reliable estimation of the prevalence of FH than hitherto possible in the general population (GP) and among patients with ASCVD.
Methods:
We performed a systematic review and meta-analysis including studies reporting on the prevalence of heterozygous FH in the GP or among those with ASCVD. Studies reporting gene founder effects and focused on homozygous FH were excluded. The search was conducted through Medline, Embase, Cochrane, and Global Health, without time or language restrictions. A random-effects model was applied to estimate the overall pooled prevalence of FH in the general and ASCVD populations separately and by World Health Organization regions.
Results:
From 3225 articles, 42 studies from the GP and 20 from populations with ASCVD were eligible, reporting on 7 297 363 individuals/24 636 cases of FH and 48 158 patients/2827 cases of FH, respectively. More than 60% of the studies were from Europe. Use of the Dutch Lipid Clinic Network criteria was the commonest diagnostic method. Within the GP, the overall pooled prevalence of FH was 1:311 (95% CI, 1:250–1:397; similar between children [1:364] and adults [1:303],
P
=0.60; across World Health Organization regions where data were available,
P
=0.29; and between population-based and electronic health records–based studies,
P
=0.82). Studies with ≤10 000 participants reported a higher prevalence (1:200–289) compared with larger cohorts (1:365–407;
P
<0.001). The pooled prevalence among those with ASCVD was 18-fold higher than in the GP (1:17 [95% CI, 1:12–1:24]), driven mainly by coronary artery disease (1:16; [95% CI, 1:12–1:23]). Between-study heterogeneity was large (
I
2
>95%). Tests assessing bias were nonsignificant (
P
>0.3).
Conclusions:
With an overall prevalence of 1:311, FH is among the commonest genetic disorders in the GP, similarly present across different regions of the world, and is more frequent among those with ASCVD. The present results support the advocacy for the institution of public health policies, including screening programs, to identify FH early and to prevent its global burden.
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Affiliation(s)
- Pengwei Hu
- Imperial Center for Cardiovascular Disease Prevention (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V.), Imperial College London, UK
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
- Department of Health Service, Logistics University of People’s Armed Police Force, Tianjin, China (P.H.)
| | - Kanika I. Dharmayat
- Imperial Center for Cardiovascular Disease Prevention (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V.), Imperial College London, UK
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
| | - Christophe A.T. Stevens
- Imperial Center for Cardiovascular Disease Prevention (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V.), Imperial College London, UK
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
| | - Mansour T.A. Sharabiani
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
| | - Rebecca S. Jones
- School of Public Health, and Charing Cross Campus Library (R.S.J.), Imperial College London, UK
| | - Gerald F. Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth (G.F.W.)
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Australia (G.F.W.)
| | - Jacques Genest
- McGill University Health Center, Montreal, QC, Canada (J.G.)
| | - Kausik K. Ray
- Imperial Center for Cardiovascular Disease Prevention (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V.), Imperial College London, UK
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
| | - Antonio J. Vallejo-Vaz
- Imperial Center for Cardiovascular Disease Prevention (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V.), Imperial College London, UK
- Department of Primary Care and Public Health (P.H., K.I.D., C.A.T.S., K.K.R., A.J.V.-V., M.T.A.S.), Imperial College London, UK
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7
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Kramer AI, Trinder M, Brunham LR. Estimating the Prevalence of Familial Hypercholesterolemia in Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Can J Cardiol 2019; 35:1322-1331. [DOI: 10.1016/j.cjca.2019.06.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
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8
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Dyrbuś K, Gąsior M, Desperak P, Osadnik T, Nowak J, Banach M. The prevalence and management of familial hypercholesterolemia in patients with acute coronary syndrome in the Polish tertiary centre: Results from the TERCET registry with 19,781 individuals. Atherosclerosis 2019; 288:33-41. [PMID: 31319356 DOI: 10.1016/j.atherosclerosis.2019.06.899] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The prevalence of familial hypercholesterolemia (FH) is high among patients with stable coronary artery disease (CAD). However, data on FH on admission among patients with acute coronary syndrome (ACS) are still relatively scarce. Therefore, we aimed to assess the prevalence, lipid-lowering therapy and short- and long-term outcomes in patients with FH among ACS patients. METHODS AND RESULTS The investigation was performed in a cohort of 19,781 consecutive patients from the TERCET Registry. There were 7319 patients admitted with ACS: 3085 due to STEMI, 2256 due to NSTEMI, and 1978 due to UA. The stable CAD group (n = 12,462) was considered the reference group. Based on the personal and familial history of premature cardiovascular disease and LDL cholesterol concentration, the Dutch Lipid Clinic Network (DLCN) algorithm was used for FH diagnosis. The overall occurrence of probable/definite FH and possible FH was 1.2% and 13.5% respectively. Among patients with ACS, 1.6% had probable/definite FH and 17.0% possible FH. The highest occurrence of FH was observed in the STEMI subgroup (20.6%). Patients with definite and probable FH had higher 30-day mortality than patients without FH (8.2% and 3.8% vs. 2.0%, respectively; p = 0.0052). No significant differences were observed between the FH groups in the 12-, 36- and 60-month follow-up. Propensity-score matching analysis showed that definite/probable FH patients had significantly higher all-cause mortality at 36- and 60-month follow-up in comparison to non-FH subjects (11.4% vs. 4.8% and 19.2% vs. 7.2%, respectively; p ≤ 0.021 for both). CONCLUSIONS The prevalence of FH according to the DLCN criteria in the Polish very high-risk population is significantly higher in patients with ACS than in patients with sCAD. FH is a cause of increased all-cause mortality in the long-term follow-up.
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Affiliation(s)
- Krzysztof Dyrbuś
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Mariusz Gąsior
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Piotr Desperak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tadeusz Osadnik
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland; Chair and Department of Pharmacology, Medical University of Silesia, School of Medicine with Division of Dentistry in Zabrze, Poland
| | - Jolanta Nowak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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