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Kinnear FJ, Perry R, Searle A, Hamilton-Shield JP, Lithander FE. How do the experiences and beliefs of adults and children with heterozygous familial hypercholesterolaemia influence their adherence to treatment? A systematic review of qualitative evidence protocol. Syst Rev 2018; 7:120. [PMID: 30111381 PMCID: PMC6094562 DOI: 10.1186/s13643-018-0793-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/02/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heterozygous familial hypercholesterolaemia (FH) is a genetic disorder characterised by elevated levels of low density lipoprotein (LDL) cholesterol from birth, estimated to affect 1 in 250 of the UK population. Left untreated, FH substantially increases an individual's risk of premature coronary heart disease (CHD) and associated mortality. This risk can be minimised with timely diagnosis and successful treatment with medication and lifestyle changes, as advocated in national and international guidelines. Despite these recommendations, the limited research available suggests adherence to treatment may be sub-optimal. This review will identify and synthesise the available qualitative research regarding the experiences and beliefs of adults and children with FH in relation to their condition and its treatment, and the influence of these upon treatment adherence. METHODS The following electronic databases will be searched from their inception: Cochrane library, MEDLINE, Embase, PsycINFO (via OVID) and CINAHL. Studies available in English and reporting primary qualitative data will be included. Database searching will be supplemented with searches in relevant specialist websites. The references of identified papers will also be hand searched. Two reviewers will independently screen titles and abstracts of identified studies, with full texts of potentially relevant papers retrieved for review against pre-defined inclusion and exclusion criteria. The Critical Appraisal Skills Programme (CASP) Qualitative Research checklist will be used to assess quality of the included studies, and the results will be taken into consideration when reporting the findings. A data extraction tool will be created for use in this review to extract study findings relevant to the review questions. A thematic synthesis approach will be taken to analyse the results. DISCUSSION Adherence to treatment recommendations is crucial for the successful management of FH and subsequent decrease in risk of CHD later in life. Common identified themes could provide an understanding of the beliefs and experiences which influence adherence to treatment recommendations and provide an insight into perceived barriers and facilitators. The findings are intended to be used in the development of future interventions or guidelines regarding treatment of children and adults with FH. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42018085946.
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Affiliation(s)
- Fiona J. Kinnear
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Aidan Searle
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Julian P. Hamilton-Shield
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Fiona E. Lithander
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
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202
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Ashfield-Watt P, Haralambos K, Edwards R, Townsend D, Gingell R, Wa Li K, Humphries SE, McDowell I. Estimation of the prevalence of cholesteryl ester storage disorder in a cohort of patients with clinical features of familial hypercholesterolaemia. Ann Clin Biochem 2018; 56:112-117. [PMID: 30056760 DOI: 10.1177/0004563218793165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Familial hypercholesterolaemia is caused by variants in the low-density lipoprotein cholesterol metabolic pathway involving LDLR, APOB and PCSK9 genes. A national genetic testing service in Wales, UK has observed that no familial hypercholesterolaemia variant is found in almost 80% patients with the familial hypercholesterolaemia phenotype. It has recently been suggested that some adult patients with a familial hypercholesterolaemia phenotype may have cholesteryl ester storage disease which can also present as a mixed hyperlipidaemia. The commonest genetic cause of cholesteryl ester storage disease is an exon 8 splice junction variant in the LIPA gene (rs116928232, c.894G>A; E8SJM) previously found to have an allele frequency of 0.0011 (1 in 450 individuals) in a large European population. This study investigated the prevalence of the E8SJM in patients with a familial hypercholesterolaemia phenotype in Wales, UK. METHOD A total of 1203 patients with a clinical suspicion of familial hypercholesterolaemia but no familial hypercholesterolaemia variant were invited to participate. Of these, 668 patients provided informed written consent. Stored DNA samples from 663 patients were genotyped for the E8SJM variant. RESULTS Three heterozygotes were identified (allele frequency 0.0023). Whole gene sequencing of the LIPA gene was undertaken in these three individuals, but no other variants were found. Therefore, there were no cholesteryl ester storage disease patients (homozygote or compound heterozygote) identified in this cohort. CONCLUSION The allele frequency 0.0023 (1 in 221 individuals) for the E8SJM variant was more prevalent in this cohort than in a European population study; however, no cholesteryl ester storage disease homozygotes were identified. We found no evidence to support routine testing for cholesteryl ester storage disease in adult patients with a familial hypercholesterolaemia phenotype.
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Affiliation(s)
- Pauline Ashfield-Watt
- 1 FH Wales Research Team, Cardiff University, Wales Heart Research Institute, Cardiff, UK
| | - Kate Haralambos
- 1 FH Wales Research Team, Cardiff University, Wales Heart Research Institute, Cardiff, UK
| | - Rhiannon Edwards
- 2 All Wales FH Cascade Testing Service, All Wales Medical Genetics Service, Cardiff, UK
| | - Delyth Townsend
- 2 All Wales FH Cascade Testing Service, All Wales Medical Genetics Service, Cardiff, UK
| | - Rob Gingell
- 2 All Wales FH Cascade Testing Service, All Wales Medical Genetics Service, Cardiff, UK
| | - Kah Wa Li
- 3 Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Steve E Humphries
- 3 Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Ian McDowell
- 1 FH Wales Research Team, Cardiff University, Wales Heart Research Institute, Cardiff, UK
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Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia is a frequent genetic disease associated with a high lifetime risk of cardiovascular disease (CVD). Statins are the cornerstone of treatment of familial hypercholesterolemia; however, with the advent of novel LDL-cholesterol lowering therapies, it has become necessary to identify familial hypercholesterolemia subjects presenting a significant residual CVD risk. The aim of this review is to provide an update on the recent literature concerning cardiovascular risk stratification in familial hypercholesterolemia. RECENT FINDINGS Recently, several clinical and genetic factors have been shown to be independent predictors of CVD in familial hypercholesterolemia. These include clinical scores such as the Montreal-FH-SCORE, novel protein biomarkers, carotid plaque score and genetic predictors such as genetic risk scores as well as single-nucleotide polymorphisms. SUMMARY Although there has been recent progress in cardiovascular risk stratification in familial hypercholesterolemia, there is still a need to further refine our knowledge concerning phenotype modifiers in this disease. Indeed, current known predictors do not explain the entirety of cardiovascular risk. More precise individual risk stratification in familial hypercholesterolemia could help to better tailor the proper therapy for each patient.
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Affiliation(s)
- Martine Paquette
- Nutrition, Metabolism and Atherosclerosis Clinic, Institut de recherches cliniques de Montréal
| | - Alexis Baass
- Nutrition, Metabolism and Atherosclerosis Clinic, Institut de recherches cliniques de Montréal
- Division of Experimental Medicine
- Division of Medical Biochemistry, Department of Medicine, McGill University, Montreal, Québec, Canada
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Baass A, Hegele RA. Getting Real With PCSK9 Inhibitors in Familial Hypercholesterolemia. Can J Cardiol 2018; 34:959-961. [DOI: 10.1016/j.cjca.2018.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
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205
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206
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Severe xanthomatosis in heterozygous familial hypercholesterolemia. J Clin Lipidol 2018; 12:872-877. [DOI: 10.1016/j.jacl.2018.03.087] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
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207
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Plana N, Rodríguez-Borjabad C, Ibarretxe D, Ferré R, Feliu A, Caselles A, Masana L. Lipid and lipoprotein parameters for detection of familial hypercholesterolemia in childhood. The DECOPIN Project. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:170-178. [PMID: 29602595 DOI: 10.1016/j.arteri.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) in children is under-detected and is difficult to diagnose in clinical practice. The aim of this study was to evaluate clinical, biochemical and vascular imaging variables in order to detect children and adolescents with FH. METHODS A total of 222 children aged 4-18 years old were recruited to participate in a project for the early detection of FH (The DECOPIN Project). They were distributed into 3groups: FH, if genetic study or clinical criteria were positive (n=91); Polygenic hypercholesterolaemia (PH) if LDL-Cholesterol >135mg/dL without FH criteria (n=23), and Control group (CG) if LDL-C <135mg/dL (n=108). Data were collected from family history, anthropometric data, and clinical variables. The usual biochemical parameters, including a complete lipid profile were analysed. The carotid intima-media thickness (cIMT) and thickness of Achilles tendons were determined using ultrasound in all participants. RESULTS A total of 91 children had a diagnosis of FH, 23 with PH, and 108 with CG. Children with FH had higher concentrations of total cholesterol, LDL-C, ApoB/ApoA1 ratio, and cholesterol-year score, than the other groups. HDL-C was lower in the FH group than in the CG. Thickness of the Achilles tendon and cIMT did not show any differences between groups, although a greater cIMT trend was observed in the FH group. ApoB/ApoA1 ratio >0.82 was the parameter with the highest sensitivity and specificity to predict the presence of mutation in children with FH. CONCLUSIONS Although LDL-C is the main biochemical parameter used to define FH, the ApoB/ApoA1 ratio (>0.82) may be a useful tool to identify children with FH and a positive mutation.
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Affiliation(s)
- Núria Plana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Unitat d'Investigació en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Reus, Tarragona, España.
| | - Cèlia Rodríguez-Borjabad
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Unitat d'Investigació en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Reus, Tarragona, España
| | - Daiana Ibarretxe
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Unitat d'Investigació en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Reus, Tarragona, España
| | - Raimon Ferré
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Unitat d'Investigació en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Reus, Tarragona, España
| | - Albert Feliu
- Unitat d'Endocrinologia Pediàtrica, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, IISPV, Reus, Tarragona, España
| | | | - Luis Masana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Unitat d'Investigació en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili (IISPV), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Reus, Tarragona, España
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208
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PHACTR1 genotype predicts coronary artery disease in patients with familial hypercholesterolemia. J Clin Lipidol 2018; 12:966-971. [DOI: 10.1016/j.jacl.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/09/2018] [Accepted: 04/22/2018] [Indexed: 01/09/2023]
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209
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Rosenson RS, Hegele RA, Fazio S, Cannon CP. The Evolving Future of PCSK9 Inhibitors. J Am Coll Cardiol 2018; 72:314-329. [DOI: 10.1016/j.jacc.2018.04.054] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 01/09/2023]
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McKay AJ, Hogan H, Humphries SE, Marks D, Ray KK, Miners A. Universal screening at age 1-2 years as an adjunct to cascade testing for familial hypercholesterolaemia in the UK: A cost-utility analysis. Atherosclerosis 2018; 275:434-443. [PMID: 29937236 DOI: 10.1016/j.atherosclerosis.2018.05.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolaemia (FH) is widely underdiagnosed. Cascade testing (CT) of relatives has been shown to be feasible, acceptable and cost-effective in the UK, but requires a supply of index cases. Feasibility of universal screening (US) at age 1-2 years was recently demonstrated. We examined whether this would be a cost-effective adjunct to CT in the UK, given the current and plausible future undiagnosed FH prevalence. METHODS Seven cholesterol and/or mutation-based US ± reverse cascade testing (RCT) alternatives were compared with no US in an incremental analysis with a healthcare perspective. A decision model was used to estimate costs and outcomes for cohorts exposed to the US component of each strategy. RCT case ascertainment was modelled using recent UK CT data, and probabilistic Markov models estimated lifetime costs and health outcomes for the cohorts screened under each alternative. 1000 Monte Carlo simulations were run for each model, and average outcomes reported. Further uncertainty was explored deterministically. Threshold analysis investigated the association between undiagnosed FH prevalence and cost-effectiveness. RESULTS A strategy involving cholesterol screening followed by diagnostic genetic testing and RCT was the most cost-effective modelled (incremental cost-effectiveness ratio (ICER) versus no US £12,480/quality adjusted life year (QALY); probability of cost-effectiveness 96·8% at £20,000/QALY threshold). Cost-effectiveness was robust to both deterministic sensitivity analyses and threshold analyses that modelled ongoing case ascertainment at theoretical maximum levels. CONCLUSIONS These findings support implementation of universal cholesterol screening followed by diagnostic genetic testing and RCT for FH, under a UK conventional willingness-to-pay threshold.
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Affiliation(s)
- Ailsa J McKay
- London School of Hygiene and Tropical Medicine, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve E Humphries
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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211
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Akioyamen LE, Genest J, Shan SD, Inibhunu H, Chu A, Tu JV. Anxiety, depression, and health-related quality of life in heterozygous familial hypercholesterolemia: A systematic review and meta-analysis. J Psychosom Res 2018; 109:32-43. [PMID: 29773150 DOI: 10.1016/j.jpsychores.2018.03.170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/24/2018] [Accepted: 03/24/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Heterozygous familial hypercholesterolemia (FH) is a common genetic disease predisposing affected individuals to a high risk of cardiovascular disease. Yet, considerable uncertainty exists regarding its impact on psychosocial wellbeing. OBJECTIVES We performed a systematic review and meta-analysis of the association between FH and symptoms of anxiety and depression, and health-related quality of life (HRQL). METHODS We searched MEDLINE, EMBASE, Global Health, the Cochrane Library, PsycINFO, and PubMed for peer-reviewed literature published in English between January 1, 1990 and January 1, 2018. Quantitative and qualitative studies were eligible if they included patients with confirmed FH and evaluated its association with symptoms of anxiety or depression, or HRQL. We performed a narrative synthesis of studies, including thematic analysis of qualitative studies, and where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals. RESULTS We found 10 eligible studies measuring HRQL, depression and anxiety. Random-effects meta-analysis of 4 (n = 4293) and 5 studies (n = 5098), respectively, showed that patients with FH had slightly lower symptoms of anxiety (SMD: -0.29 [95% CI: -0.53, -0.04]) and mental HRQL (SMD: -0.10 [95% -0.20, -0.00]) relative to general population controls. No significant differences existed in depressive symptoms (SMD: 0.04 [95% CI: -0.12, 0.19]) or physical HRQL scores (SMD: 0.02 [95% CI: -0.09, 0.12]). CONCLUSIONS Our systematic review suggests that patients with FH may report small but measurable differences in anxiety symptoms and mental HRQL.
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Affiliation(s)
- Leo E Akioyamen
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Jacques Genest
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; McGill University Health Centre, Royal Victoria Hospital, Montreal, QC H3A 1A1, Canada.
| | - Shubham D Shan
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Happy Inibhunu
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada.
| | - Anna Chu
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
| | - Jack V Tu
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
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212
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Agirbasli D, Hyatt T, Agirbasli M. Familial hypercholesterolemia with extensive coronary artery disease and tuberous and tendinous xanthomas: A case report and mutation analysis. J Clin Lipidol 2018; 12:863-867. [PMID: 29784571 DOI: 10.1016/j.jacl.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Abstract
This is a case report of a 38-year-old Syrian refugee male with early-onset extensive atherosclerosis. The physical and laboratory examination were remarkable with severe xanthomas in the upper and lower extremities and with low-density lipoprotein cholesterol (LDL-C) 417 mg/dL, total cholesterol 495 mg/dL, high-density lipoprotein cholesterol 30 mg/dL, and triglycerides 242 mg/dL. LDL-C level responded poorly to the high-dose statin treatment. The genetic analysis indicated that the patient had a large homozygous deletion in LDL receptor gene including the exons 7-14. A 12-kb deletion had occurred between the 2 Alu repetitive sequences that were oriented in opposite directions, one in intron 6 and the other in intron 14. This deletion eliminated exons 7-14, which exactly corresponded to the entire exon sequence coding the epidermal growth factor precursor homology domain. This deletion in LDL receptor was previously reported. This rare case of homozygous familial hypercholesterolemia presenting with multiple large and widely distributed xanthomas implicates the need for novel treatment options in familial hypercholesterolemia patients. The case is a Syrian refugee and emphasizes the urgent need to address orphan disease in refugee populations throughout the world.
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Affiliation(s)
- Deniz Agirbasli
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, Department of Medical Biology, İstanbul, Turkey
| | - Tommy Hyatt
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mehmet Agirbasli
- Medeniyet University Medical Center, Department of Cardiology, İstanbul, Turkey.
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213
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Simplified Canadian Definition for Familial Hypercholesterolemia. Can J Cardiol 2018; 34:1210-1214. [PMID: 30093300 DOI: 10.1016/j.cjca.2018.05.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal codominant lipoprotein disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) and high risk of premature atherosclerotic cardiovascular disease. Definitions for FH rely on complex algorithms that are on the basis of levels of total or LDL-C, clinical features, family history, and DNA analysis that are often difficult to obtain. We propose a novel simplified definition for FH. Definite FH includes: (1) elevated LDL-C (≥ 8.50 mmol/L); or (2) LDL-C ≥ 5.0 mmol/L (for age 40 years or older; ≥ 4.0 mmol/L if age younger than 18 years; and ≥ 4.5 mmol/L if age is between 18 and 39 years) when associated with at least 1 of: (1) tendon xanthomas; or (2) causal DNA mutation in the LDLR, APOB, or PCSK9 genes in the proband or first-degree relative. Probable FH is defined as subjects with an elevated LDL-C (≥ 5.0 mmol/L) and the presence of premature atherosclerotic cardiovascular disease in the patient or a first-degree relative or an elevated LDL-C in a first-degree relative. LDL-C cut points were determined from a large database comprising > 3.3 million subjects. To compare the proposed definition with currently used algorithms (ie, the Simon Broome Register and Dutch Lipid Clinic Network), we performed concordance analyses in 5987 individuals from Canada. The new FH definition showed very good agreement compared with the Simon Broome Register and Dutch Lipid Clinic Network criteria (κ = 0.969 and 0.966, respectively). In conclusion, the proposed FH definition has diagnostic performance comparable to existing criteria, but adapted to the Canadian population, and will facilitate the diagnosis of FH patients.
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214
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Abstract
PURPOSE OF REVIEW There has recently been renewed interest in the study of the various facets of familial hypercholesterolemia, a severe monogenic disease associated with elevated LDL-cholesterol and premature cardiovascular disease (CVD). In the present review, novel data presenting the frequency of familial hypercholesterolemia as well as factors modulating the cardiovascular risk in familial hypercholesterolemia will be discussed. RECENT FINDINGS Recent studies have showed that familial hypercholesterolemia is much more prevalent than initially thought. Classically, it was estimated that familial hypercholesterolemia affected one in 500 people worldwide, but a recent large-scale meta-analysis has shown a prevalence closer to one in 250. In the French-Canadian population, this disease is even more frequent reaching one in 81 in certain regions of the Province of Quebec. Several novel studies in the French-Canadian population have shown that the clinical outcomes in familial hypercholesterolemia seem to be greatly influenced by risk factors other than LDL-cholesterol. Also, scores to predict CVD in familial hypercholesterolemia have been recently proposed. SUMMARY Familial hypercholesterolemia is more frequent than initially thought and the phenotype of this disease can be variable. Indeed, both clinical and genetic variables can modulate the CVD risk in this population.
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Affiliation(s)
- Martine Paquette
- Nutrition, Metabolism and Atherosclerosis Clinic, Institut de recherches cliniques de Montréal
| | - Jacques Genest
- Division of cardiology, The McGill University Health Centre
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Smyth N, Ramsay M, Raal FJ. Population specific genetic heterogeneity of familial hypercholesterolemia in South Africa. Curr Opin Lipidol 2018; 29:72-79. [PMID: 29369830 DOI: 10.1097/mol.0000000000000488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW To describe the prevalence and population-specific genetic heterogeneity of familial hypercholesterolemia in South Africa. RECENT FINDINGS This review highlights the paucity of data on familial hypercholesterolemia in South Africa, and the urgent need to uncover the mutation profiles in lipid-associated genes, causing an increase in LDL-cholesterol in the different ethnic groups. Case reports and small studies have shown that familial hypercholesterolemia, although apparently uncommon, is present in black Africans. SUMMARY Local founder effects have led to an increased prevalence of familial hypercholesterolemia in several South African populations: Afrikaner founder mutations (c.681 C>G, c.1285 G>A, c.523 G>A), Ashkenazi founder mutation (c.654_656del) and possible Indian founder mutation (c.2054 C>T). Preliminary data in black Africans with elevated LDL-cholesterol identified a possible common mutation, c.137_142del. The South African multiethnic society and well described founder effects emphasize the need for differential approaches to diagnosis and management of familial hypercholesterolemia. Studies involving larger cohorts and inclusive of different ethnicities are paramount to establishing an accurate prevalence of familial hypercholesterolemia in black Africans, not only in South Africa but in the Sub-Saharan African region. It is clear that the estimated world prevalence of one in 250 cannot be generally applied across African populations.
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Affiliation(s)
| | | | - Frederick J Raal
- Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Ruel I, Aljenedil S, Sadri I, de Varennes É, Hegele RA, Couture P, Bergeron J, Wanneh E, Baass A, Dufour R, Gaudet D, Brisson D, Brunham LR, Francis GA, Cermakova L, Brophy JM, Ryomoto A, Mancini GBJ, Genest J. Imputation of Baseline LDL Cholesterol Concentration in Patients with Familial Hypercholesterolemia on Statins or Ezetimibe. Clin Chem 2018; 64:355-362. [DOI: 10.1373/clinchem.2017.279422] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/31/2017] [Indexed: 01/27/2023]
Abstract
Abstract
BACKGROUND
Familial hypercholesterolemia (FH) is the most frequent genetic disorder seen clinically and is characterized by increased LDL cholesterol (LDL-C) (>95th percentile), family history of increased LDL-C, premature atherosclerotic cardiovascular disease (ASCVD) in the patient or in first-degree relatives, presence of tendinous xanthomas or premature corneal arcus, or presence of a pathogenic mutation in the LDLR, PCSK9, or APOB genes. A diagnosis of FH has important clinical implications with respect to lifelong risk of ASCVD and requirement for intensive pharmacological therapy. The concentration of baseline LDL-C (untreated) is essential for the diagnosis of FH but is often not available because the individual is already on statin therapy.
METHODS
To validate a new algorithm to impute baseline LDL-C, we examined 1297 patients. The baseline LDL-C was compared with the imputed baseline obtained within 18 months of the initiation of therapy. We compared the percent reduction in LDL-C on treatment from baseline with the published percent reductions.
RESULTS
After eliminating individuals with missing data, nonstandard doses of statins, or medications other than statins or ezetimibe, we provide data on 951 patients. The mean ± SE baseline LDL-C was 243.0 (2.2) mg/dL [6.28 (0.06) mmol/L], and the mean ± SE imputed baseline LDL-C was 244.2 (2.6) mg/dL [6.31 (0.07) mmol/L] (P = 0.48). There was no difference in response according to the patient's sex or in percent reduction between observed and expected for individual doses or types of statin or ezetimibe.
CONCLUSIONS
We provide a validated estimation of baseline LDL-C for patients with FH that may help clinicians in making a diagnosis.
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Affiliation(s)
- Isabelle Ruel
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
| | - Sumayah Aljenedil
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
| | - Iman Sadri
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
| | - Émilie de Varennes
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, Schulich School of Medicine and Robarts Research Institute, Western University, London, ON, Canada
| | - Patrick Couture
- Lipid Research Centre, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Jean Bergeron
- Lipid Research Centre, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Eric Wanneh
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexis Baass
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
- Nutrition, Metabolism, and Atherosclerosis Clinic, Institut de recherches cliniques de Montréal, QC, Canada
- Division of Medical Biochemistry, Department of Medicine, McGill University, QC, Canada
| | - Robert Dufour
- Department of Nutrition, Université de Montréal, Montreal, QC, Canada
| | - Daniel Gaudet
- Lipidology Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Saguenay, QC, Canada
| | - Diane Brisson
- Lipidology Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Saguenay, QC, Canada
| | - Liam R Brunham
- Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Gordon A Francis
- Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Lubomira Cermakova
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James M Brophy
- McGill University, Royal Victoria Hospital, Montreal, QC, Canada
| | - Arnold Ryomoto
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - G B John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
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Hegele RA. Learning From Patients With Ultrarare Conditions. J Am Coll Cardiol 2018; 71:289-291. [DOI: 10.1016/j.jacc.2017.09.1158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/19/2023]
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Alonso R, Perez de Isla L, Muñiz-Grijalvo O, Diaz-Diaz JL, Mata P. Familial Hypercholesterolaemia Diagnosis and Management. Eur Cardiol 2018; 13:14-20. [PMID: 30310464 DOI: 10.15420/ecr.2018:10:2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Familial hypercholesterolaemia is the most common monogenic disorder associated with premature coronary artery disease. Mutations are most frequently found in the LDL receptor gene. Clinical criteria can be used to make the diagnosis; however, genetic testing will confirm the disorder and is very useful for cascade screening. Early identification and adequate treatment can improve prognosis, reducing negative clinical cardiovascular outcomes. Patients with familial hypercholesterolaemia are considered at high cardiovascular risk and the treatment target is LDL cholesterol <2.6 mmol/l or at least a 50 % reduction in LDL cholesterol. Patients require intensive treatment with statins and ezetimibe and/or colesevelam. Recently, proprotein convertase subtilisin/kexin type 9 inhibitors have been approved for the management of familial hypercholesterolaemia on top of statins.
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Affiliation(s)
- Rodrigo Alonso
- Department of Nutrition, Clínica Las Condes Santiago, Chile
| | - Leopoldo Perez de Isla
- Cardiology Department, Clinical Hospital San Carlos, IDISSC, Complutense University Madrid, Spain
| | | | - Jose Luis Diaz-Diaz
- Department of Internal Medicine, University A Coruña Hospital A Coruña, Spain
| | - Pedro Mata
- Spanish Familial Hypercholesterolemia Foundation Madrid, Spain
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