P818Incidence of coronary heart disease in patients with familiar hypercholesterolemia compared to age- and sex- matched controls

Background

Familial hypercholesterolemia (FH) is caused by mutations leading to high levels of low-density lipoprotein cholesterol (LDL-C) in the blood. The primary aim was to describe mutations in a large sample of individuals with FH, and compare risk of first-time hospitalization for coronary heart disease (CHD) and acute myocardial infarction (AMI) between FH mutation carriers and healthy controls. The secondary aim was to compare risk of death and re-hospitalization among FH mutation carriers and controls with a first event of CHD and AMI.

Methods

This study is a prospective matched cohort study comprising a sample of 5691 persons with FH and 119 511 age- and sex- matched controls randomly selected from the general Norwegian population. Information on CHD and AMI were obtained from Norwegian Patient Registry, the Cardiovascular Disease in Norway project and the Norwegian Cause of Death Registry. Endpoints are defined according to the International Classification of Diseases, version 9 (ICD9) or version 10 (ICD10). Risk among persons with FH will be compared to healthy controls in terms of hazard ratios (HR) from Cox regression with follow-up time calculated from time of FH-diagnosis for the person with FH in each matched set.

Results

In total 51.8% (n=61866) of the combined sample were women with mean age 49.0±20.3 years, whereas 48.2% (n=57645) were men with mean age 46.8±19.6 years. There were 236 different FH mutations registered among the FH mutation carriers. The most frequent mutation was 313+1g>A, that accounted for 20.7% (n=1178) of the total, followed by C210G with 12.1% (n=690). Results for incidence of CHD, AMI, and mortality after CHD and AMI and readmission rates are not yet available but will be presented at the conference.

Acknowledgement/Funding

The study is funded by South-Eastern Norway Regional Health Authority

[Transesophageal echocardiography at a small Norwegian district hospital]

Transoesophageal echocardiography in a routine setting in a small Norwegian district hospital (catchment area population 30,000) during a 12-month period is presented. The method is relatively new and is seldom used at district hospitals. We therefore find it of interest to report our experience with the method. During 1998 a total of 868 echocardiographies were performed, 167 of which were transoesophageal. Our hospital had at that time three people performing the investigation, two of which were cardiologists. The mean age of patients was 69.9 years; men 68.4, women 71.8 years. 60% of the investigations were on inpatients; 40% of the transoesophageal investigations were performed as emergencies or subacutely. The transoesophageal echoes were performed following the usual application criteria: 56 were done to evaluate possible cardial source of embolism, 32 valve disease, 24 to verify or follow endocarditis, 14 patients were seen prior to electroconversion. In six of these, large thrombi in the left-side cardiac chambers were found and electroconversion was not performed. All these patients had been on well controlled anticoagulant treatment for three or more weeks prior to the investigation. Seven patients were studied due to probable aortic pathology. Patients with emphysema, chronic lung disease, radiation sequelae or others with no parasternal or subxiphoid access had transoesophageal echo performed. Intravenous diazepam was only used in four of 167 investigations. This was of great importance for including the method in our outpatient clinic routine. The frequent observation of intracardiac thrombi has let us to incorporate transoesophageal echocardiography into a routine setting for all patients prior to electroconversion and for those with stroke in order to optimise treatment.