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Iatan I, Akioyamen LE, Ruel I, Guerin A, Hales L, Coutinho T, Brunham LR, Genest J. Sex differences in treatment of familial hypercholesterolaemia: a meta-analysis. Eur Heart J 2024:ehae417. [PMID: 38976372 DOI: 10.1093/eurheartj/ehae417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/20/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND AIMS Familial hypercholesterolaemia (FH) is a highly prevalent monogenic disorder characterized by elevated LDL cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease. Sex disparities in diagnosis, lipid-lowering therapy, and achieved lipid levels have emerged worldwide, resulting in barriers to care in FH. A systematic review was performed to investigate sex-related disparities in treatment, response, and lipid target achievement in FH (PROSPERO, CRD42022353297). METHODS MEDLINE, Embase, The Cochrane library, PubMed, Scopus, PsycInfo, and grey literature databases were searched from inception to 26 April 2023. Records were eligible if they described sex differences in the treatment of adults with FH. RESULTS Of 4432 publications reviewed, 133 met our eligibility criteria. In 16 interventional clinical trials (eight randomized and eight non-randomized; 1840 participants, 49.4% females), there were no differences between males and females in response to fixed doses of lipid-lowering therapy, suggesting that sex was not a determinant of response. Meta-analysis of 25 real-world observational studies (129 441 participants, 53.4% females) found that females were less likely to be on lipid-lowering therapy compared with males (odds ratio .74, 95% confidence interval .66-.85). Importantly, females were less likely to reach an LDL-C < 2.5 mmol/L (odds ratio .85, 95% confidence interval .74-.97). Similarly, treated LDL-C levels were higher in females. Despite this, male sex was associated with a two-fold greater relative risk of major adverse cardiovascular events including myocardial infarction, atherosclerotic cardiovascular disease, and cardiovascular mortality. CONCLUSIONS Females with FH were less likely to be treated intensively and to reach guideline-recommended LDL-C targets. This sex bias represents a surmountable barrier to clinical care.
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Affiliation(s)
- Iulia Iatan
- Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leo E Akioyamen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Ruel
- Department of Medicine, Research Institute of the McGill University Health Centre, 1001, Decarie blvd. Office EM1.2212, Montreal, Quebec H4A 3J1, Canada
| | - Amanda Guerin
- Department of Medicine, Research Institute of the McGill University Health Centre, 1001, Decarie blvd. Office EM1.2212, Montreal, Quebec H4A 3J1, Canada
| | - Lindsay Hales
- McGill University Health Center Libraries, Montreal, Quebec, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Liam R Brunham
- Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacques Genest
- Department of Medicine, Research Institute of the McGill University Health Centre, 1001, Decarie blvd. Office EM1.2212, Montreal, Quebec H4A 3J1, Canada
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Yu Y, Chen L, Zhang H, Fu Z, Liu Q, Zhao H, Liu Y, Chen Y. Association Between Familial Hypercholesterolemia and Risk of Cardiovascular Events and Death in Different Cohorts: A Meta-Analysis of 1.1 Million Subjects. Front Cardiovasc Med 2022; 9:860196. [PMID: 35800161 PMCID: PMC9253470 DOI: 10.3389/fcvm.2022.860196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Aims The association of familial hypercholesterolemia (FH) with risk of cardiovascular events (CVE) and death in different cohorts is controversial. We aimed to assess the risk of CVE and death in patients with FH in different cohorts, including CHD and ACS patients, White and Asian, different diagnostic criteria. Methods We searched PubMed, MEDLINE, and Web of Science electronic databases through May 2021 to identify cohort studies of CVE and death in patients with FH. Results We found 18 eligible studies with 1,139,788 participants, including 34,261 patients. There were 31,287 ACS patients, of whom 2,338 were combined with FH. Randomized-effects meta-analysis showed that in patients with FH, relative risk (RR) of CVE and death was 1.87 (95% CI 1.21–2.88), among which CVE was 2.14 (95%CI 1.26–3.64), all-cause of death RR = 1.12 (95% CI 0.89–1.41), and cardiac death RR = 1.03 (95% CI 0.59–1.79). Risk of CVE and death in general population with FH was 2.85 (95% CI 0.72–11.21), hyperlipidemia population RR = 1.59 (95% CI 1.05–2.41), coronary heart disease patients (CHD) RR = 1.46 (95% CI 1.24–1.72), and acute coronary syndrome patients (ACS) RR = 1.71 (95% CI 1.19–2.46). Among ACS patients, the RR of CVE in patients with FH was 1.91 (95% CI 1.55–2.35), the RR of all-cause of death was 1.03 (95% CI 0.80–1.32), and the RR of cardiac death was 1.03 (95% CI 0.59–1.79). The risk of CVE and death in ACS patients with FH in White was 1.69 (95% CI 1.09–2.64) and Asian 1.90 (95% CI 1.31–2.75). RR in patients with Dutch Lipid Network criteria (DLCN) ≥6 vs. <3 points was higher (RR = 2.24, 95% CI 1.69–2.97). RR for long-term follow-up was 1.68 (95% CI 1.09–2.61) and for short-term follow-up was 1.80 (95% CI 1.16–2.78). The results of the overall population were similar, but RR for overall population during a short-term follow-up was 1.49 (95% CI 0.81–2.73). We followed PRISMA checklist to complete meta-analysis. Conclusions The risk of CVE and death was increased in patients with CHD, especially in patients with ACS. DLCN ≥ 6 points was suggested for clinical diagnosis of FH. The risk of long-term and short-term CVE and death increased in ACS patients with FH. Registration Number INPLASY2021110010.
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Affiliation(s)
- Yani Yu
- Medical College of Nankai University, Tianjing, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lei Chen
- Medical College of Nankai University, Tianjing, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Honghong Zhang
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zihao Fu
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qi Liu
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haijing Zhao
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuqi Liu
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yuqi Liu
| | - Yundai Chen
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Yundai Chen
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3
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Németh Á, Daróczy B, Juhász L, Fülöp P, Harangi M, Paragh G. Assessment of Associations Between Serum Lipoprotein (a) Levels and Atherosclerotic Vascular Diseases in Hungarian Patients With Familial Hypercholesterolemia Using Data Mining and Machine Learning. Front Genet 2022; 13:849197. [PMID: 35222552 PMCID: PMC8864223 DOI: 10.3389/fgene.2022.849197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aims: Premature mortality due to atherosclerotic vascular disease is very high in Hungary in comparison with international prevalence rates, though the estimated prevalence of familial hypercholesterolemia (FH) is in line with the data of other European countries. Previous studies have shown that high lipoprotein(a)- Lp(a) levels are associated with an increased risk of atherosclerotic vascular diseases in patients with FH. We aimed to assess the associations of serum Lp(a) levels and such vascular diseases in FH using data mining methods and machine learning techniques in the Northern Great Plain region of Hungary. Methods: Medical records of 590,500 patients were included in our study. Based on the data from previously diagnosed FH patients using the Dutch Lipid Clinic Network scores (≥7 was evaluated as probable or definite FH), we trained machine learning models to identify FH patients. Results: We identified 459 patients with FH and 221 of them had data available on Lp(a). Patients with FH had significantly higher Lp(a) levels compared to non-FH subjects [236 (92.5; 698.5) vs. 167 (80.2; 431.5) mg/L, p < .01]. Also 35.3% of FH patients had Lp(a) levels >500 mg/L. Atherosclerotic complications were significantly more frequent in FH patients compared to patients without FH (46.6 vs. 13.9%). However, contrary to several other previous studies, we could not find significant associations between serum Lp(a) levels and atherosclerotic vascular diseases in the studied Hungarian FH patient group. Conclusion: The extremely high burden of vascular disease is mainly explained by the unhealthy lifestyle of our patients (i.e., high prevalence of smoking, unhealthy diet and physical inactivity resulting in obesity and hypertension). The lack of associations between serum Lp(a) levels and atherosclerotic vascular diseases in Hungarian FH patients may be due to the high prevalence of these risk factors, that mask the deleterious effect of Lp(a).
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Affiliation(s)
- Ákos Németh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Bálint Daróczy
- Institute for Computer Science and Control, Hungarian Academy of Sciences, (MTA SZTAKI), Budapest, Hungary
- Université Catholique de Louvain, INMA, Louvain-la-Neuve, Belgium
| | - Lilla Juhász
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter Fülöp
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Harangi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: György Paragh,
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Probst-Hensch N, Bochud M, Chiolero A, Crivelli L, Dratva J, Flahault A, Frey D, Kuenzli N, Puhan M, Suggs LS, Wirth C. Swiss Cohort & Biobank - The White Paper. Public Health Rev 2022; 43:1605660. [PMID: 36619237 PMCID: PMC9817110 DOI: 10.3389/phrs.2022.1605660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- *Correspondence: Nicole Probst-Hensch,
| | - Murielle Bochud
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland
| | - Arnaud Chiolero
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Luca Crivelli
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
- Institute of Public Health Università della Svizzera Italiana, Lugano, Switzerland
| | - Julia Dratva
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Institute of Public Health, Department of Health Sciences, ZHAW Zürich University of Applied Sciences, Winterthur, Switzerland
| | - Antoine Flahault
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Frey
- Swiss Society for Public Health, Bern, Switzerland
| | - Nino Kuenzli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
| | - Milo Puhan
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - L. Suzanne Suggs
- Swiss School of Public Health (SSPH+), Zürich, Switzerland
- Swiss Society for Public Health, Bern, Switzerland
- Institute of Public Health Università della Svizzera Italiana, Lugano, Switzerland
| | - Corina Wirth
- Swiss Society for Public Health, Bern, Switzerland
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Silva PRDS, Jannes CE, Oliveira TG, Krieger JE, Santos RD, Pereira AC. Pharmacological treatment with lipid-lowering agents after molecular identification of familial hypercholesterolemia: results from the Hipercol Brasil cohort. J Clin Lipidol 2022; 16:198-207. [DOI: 10.1016/j.jacl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Rocha VZ, Santos RD. Past, Present, and Future of Familial Hypercholesterolemia Management. Methodist Debakey Cardiovasc J 2021; 17:28-35. [PMID: 34824679 PMCID: PMC8588698 DOI: 10.14797/mdcvj.887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a monogenic form of severe hypercholesterolemia that, if left untreated, is associated with early onset of atherosclerosis. FH derives from genetic variants that lead to inefficient hepatic clearance of low-density lipoprotein (LDL) particles from the circulation. The FH phenotype is encountered in approximately 1 of every 300 people. The risk of atherosclerotic cardiovascular disease (ASCVD) is higher in those with FH than in normolipidemic individuals and in those with polygenic hypercholesterolemia. FH is usually diagnosed by clinical scores that consider hypercholesterolemia, family history of early ASCVD and hypercholesterolemia, and cutaneous stigmata. Genetic diagnosis is important and should be offered to individuals suspected of FH. Family cascade screening is important to identify asymptomatic hypercholesterolemic individuals. Despite the high risk of ASCVD, this risk is heterogenous in heterozygous FH and depends not only on high LDL cholesterol (LDL-C) but also on other risk biomarkers. Risk can be evaluated by considering biomarkers such as male sex, late-onset therapy (> age 40), LDL-C > 310 mg/dL, low high-density lipoprotein cholesterol, elevated lipoprotein(a), obesity, diabetes, and hypertension by using specific risk equations and by detecting subclinical coronary atherosclerosis. Statins are the main therapy for FH and change the natural history of ASCVD; however, most individuals persist with elevated LDL-C. PCSK9 inhibitors provide robust and safe LDL-C lowering in FH, although elevated costs preclude their widespread use. Newer therapies such as ANGPTL3 inhibitors add intensive LDL-C lowering for refractory forms of FH. Finally, while it is possible to normalize LDL-C in people with FH, the disease unfortunately is still severely underdiagnosed and undertreated.
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Affiliation(s)
- Viviane Z Rocha
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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7
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Pedro-Botet J, Climent E, Benaiges D. Familial Hypercholesterolemia: Do HDL Play a Role? Biomedicines 2021; 9:biomedicines9070810. [PMID: 34356876 PMCID: PMC8301335 DOI: 10.3390/biomedicines9070810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) in heterozygous familial hypercholesterolemia (HeFH), the most frequent monogenic disorder of human metabolism, is largely driven by low-density lipoprotein (LDL) cholesterol concentrations. Since the CVD rate differs considerably in this population, beyond the lifetime LDL cholesterol vascular accumulation, other classical risk factors are involved in the high cardiovascular risk of HeFH. Among other lipoprotein disturbances, alterations in the phenotype and functionality of high-density lipoproteins (HDL) have been described in HeFH patients, contributing to the presence and severity of CVD. In fact, HDL are the first defensive barrier against the burden of high LDL cholesterol levels owing to their contribution to reverse cholesterol transport as well as their antioxidant and anti-inflammatory properties, among others. In this context, the present narrative review aimed to focus on quantitative and qualitative abnormalities in HDL particles in HeFH, encompassing metabolic, genetic and epigenetic aspects.
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Affiliation(s)
- Juan Pedro-Botet
- Endocrinology and Nutrition Department, Hospital del Mar, 08003 Barcelona, Spain; (E.C.); (D.B.)
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, 08003 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
- Correspondence: ; Tel.: +34-932483902; Fax: +34-932483254
| | - Elisenda Climent
- Endocrinology and Nutrition Department, Hospital del Mar, 08003 Barcelona, Spain; (E.C.); (D.B.)
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, 08003 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - David Benaiges
- Endocrinology and Nutrition Department, Hospital del Mar, 08003 Barcelona, Spain; (E.C.); (D.B.)
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, 08003 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
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8
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Katamine M, Minami Y, Hashimoto T, Ako J. Familial hypercholesterolemia and vulnerability of coronary plaque in patients with coronary artery disease. Pract Lab Med 2021; 24:e00202. [PMID: 33659602 PMCID: PMC7895842 DOI: 10.1016/j.plabm.2021.e00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/13/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives Patients with familial hypercholesterolemia (FH) are at a very high risk of coronary artery diseases. The aim of the present study was to clarify the characteristics of coronary plaque in patients with FH. Design and Methods: A total of 569 patients who underwent optical coherence tomography (OCT) imaging of culprit plaque were included. The characteristics of culprit plaque were compared between patients with and without FH. Results A total of 38 patients (6.7%) were clinically diagnosed with FH. The location of the culprit plaque was significantly different (p < 0.001) with a trend toward higher frequency of left main lesion in the FH group than in the group with no FH (7.9 vs. 0%). Culprit plaque was significantly shorter in patients with FH than those without FH (28.1 vs. 33.2 mm, p = 0.016). A trend toward higher prevalence of plaque with macrophage accumulation in patients with FH than those without FH (50.0 vs. 34.7%, p = 0.056) was observed, although the prevalence of other vulnerable characteristics including thin-cap fibroatheroma (TCFA) was comparable between patients with and without FH. Among patients with FH, significant increases in the prevalence of lipid-rich plaque (p = 0.028) and TCFA (p = 0.003) were observed according to the increase in low-density lipoprotein cholesterol (LDL-C) levels. Conclusions Patients with FH had shorter culprit plaque without significant difference in the prevalence of vulnerable plaque components compared with patients without FH. A higher LDL-C level was associated with higher prevalence of vulnerable plaque in patients with FH.
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Affiliation(s)
| | - Yoshiyasu Minami
- Corresponding author. Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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9
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Pereira AC. A roadmap for familial hypercholesterolaemia control. Lancet Digit Health 2019; 1:e376-e377. [PMID: 33323213 DOI: 10.1016/s2589-7500(19)30161-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 06/12/2023]
Affiliation(s)
- Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo 05403-000, Brazil; Hipercol Brasil Program, São Paulo, Brazil.
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Miname MH, Bittencourt MS, Nasir K, Santos RD. Subclinical coronary atherosclerosis and cardiovascular risk stratification in heterozygous familial hypercholesterolemia patients undergoing statin treatment. Curr Opin Lipidol 2019; 30:82-87. [PMID: 30649025 DOI: 10.1097/mol.0000000000000573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To discuss the heterogeneity of atherosclerotic cardiovascular disease (ASCVD) risk in heterozygous familial hypercholesterolemia and evidence and limitations of clinical risk scores and subclinical coronary atherosclerosis (SCA) imaging to evaluate risk. RECENT FINDINGS Risk evaluation in contemporary familial hypercholesterolemia cohorts needs to consider the cause of the familial hypercholesterolemia phenotype, for example the presence of autosomal molecular defects that impart a greater ASCVD risk than in polygenic hypercholesterolemia, prospective follow-up and the impact of statin treatment. As atherosclerosis is multifactorial, clinical scores like the Montreal familial hypercholesterolemia score and SAFEHEART risk equation have been proposed to stratify ASCVD in statin-treated, molecularly defined familial hypercholesterolemia individuals. However, these scores need further validation. SCA distribution in familial hypercholesterolemia individuals undergoing conventional lipid-lowering treatment is heterogeneous, with 45-50% of individuals not presenting any coronary artery calcification (CAC). One study suggests that the absence of CAC associates with no ASCVD events in asymptomatic familial hypercholesterolemia individuals undergoing statin therapy despite elevated residual LDL-cholesterol levels. In contrast, the presence of CAC was independently associated with ASCVD events. SUMMARY ASCVD risk is heterogeneous in statin-treated familial hypercholesterolemia individuals. Further studies are necessary to determine how risk stratification, especially with SCA detection, impacts on prescription of proprotein convertase subtilisin kexin type 9 inhibitors within a cost-constrained environment.
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Affiliation(s)
- Marcio H Miname
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital
| | - Marcio S Bittencourt
- Hospital Israelita Albert Einstein
- School of Medicine, Faculdade Israelita de Cie[Combining Circumflex Accent]ncia da Sau[Combining Acute Accent]de Albert Einstein
- Center for Clinical and Epidemiological Research, University Hospital and Sa[Combining Tilde]o Paulo State Cancer Institute, University of Sa[Combining Tilde]o Paulo, Sa[Combining Tilde]o Paulo, Brazil
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation and Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital
- Hospital Israelita Albert Einstein
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11
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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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Mata P, Alonso R, Pérez de Isla L. Atherosclerotic cardiovascular disease risk assessment in familial hypercholesterolemia: does one size fit all? Curr Opin Lipidol 2018; 29:445-452. [PMID: 30382952 DOI: 10.1097/mol.0000000000000553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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 hypercholesterolemia is a frequent genetic disease associated with lifelong elevation of LDL-cholesterol and premature atherosclerotic cardiovascular disease (ASCVD). Statins are the cornerstone of treatment. However, with the introduction of novel LDL-cholesterol-lowering therapies, it is necessary to identify familial hypercholesterolemia patients presenting a significantly high residual ASCVD risk. The aim of this review is to provide an update on the recent literature concerning cardiovascular risk stratification including the role of coronary imaging. RECENT FINDINGS Several factors have shown to be independent predictors of ASCVD in familial hypercholesterolemia. These include clinical scores with cardiovascular risk factors, coronary imaging and novel protein biomarkers. However, the recent introduction of the SAFEHEART risk-equation (SAFEHEART-RE) could allow a more accurate ASCVD risk prediction in familial hypercholesterolemia. SUMMARY This article highlights the SAFEHEART-RE as a model to predict incident ASCVD in familial hypercholesterolemia. This equation is a simple and widely applicable tool for use in every clinical setting. Furthermore, coronary atherosclerosis assessed by coronary computed-tomographic angiography (coronary-CTA) is independently associated to the cardiovascular risk estimated according to the SAFEHEART-RE. This equation, as well as coronary-CTA and new biomarkers, could increase individual ASCVD risk stratification and could improve the efficiency and the use of new lipid-lowering therapies in familial hypercholesterolemia.
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Affiliation(s)
- Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Nutrition Department, Clínica las Condes, Santiago de Chile, Chile
| | - Leopoldo Pérez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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13
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Silva PRDS, Jannes CE, Oliveira TGM, Gómez LMG, Krieger JE, Santos RD, Pereira AC. Predictors of Family Enrollment in a Genetic Cascade Screening Program for Familial Hypercholesterolemia. Arq Bras Cardiol 2018; 111:578-584. [PMID: 30156605 PMCID: PMC6199512 DOI: 10.5935/abc.20180156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/25/2018] [Indexed: 12/02/2022] Open
Abstract
Background Genetic cascade screening is the most cost-effective method for the
identification of individuals with familial hypercholesterolemia (FH), but
the best strategies for the enrollment of at-risk individuals in a FH
screening program are not fully known. Objective The aim of this study is to identify the best predictors of familial
enrollment into genetic screening, using features derived from tested
probands. Methods One hundred and eighty-three index-cases (ICs) with a positive genetic result
that had relatives screened from 01/2011 to 07/2015 were included. The
response variable was the number of relatives for each enrolled IC. All
variables in the study were based on ICs’ derived clinical and
socioeconomical features. The effect size of predictor variables were
obtained through a general linear model using a negative binomial regression
link function. Significance was considered with a p < 0.05. Results Mean IC age when enrolling into the program was 50 years old; 78.1% of
individuals reported knowledge of relatives with dyslipidemia. Mean baseline
LDL-cholesterol level was 316 ± 90 mg/dL. Referral origin through the
cascade program website vs. tertiary care, IC LDL-cholesterol and familial
history of high LDL-cholesterol levels were independent predictors
associated with a higher number of enrolled relatives. Conclusions Our data suggest that FH cascade screening programs can predict family
enrollment based on IC features. This information may be useful for devising
better and more effective screening approaches for at-risk individuals.
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Affiliation(s)
- Pãmela Rodrigues de Souza Silva
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Cinthia Elim Jannes
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Theo G M Oliveira
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Luz Marina Gómez Gómez
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - José E Krieger
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Raul D Santos
- Clínica de Lípides do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Alexandre Costa Pereira
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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14
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Badimon L, Padró T, Cubedo J. Protein changes in non-LDL-lipoproteins in familial hypercholesterolemia: implications in cardiovascular disease manifestation and outcome. Curr Opin Lipidol 2017; 28:427-433. [PMID: 28682808 DOI: 10.1097/mol.0000000000000441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia, represents one of the most extreme clinical entities associated with premature coronary artery disease (CAD). However, clinical manifestation of CAD varies across cohorts and individual patients suggesting the existence of additional non-LDL factors potentially contributing to their cardiovascular burden. RECENT FINDINGS Changes in HDL-associated proteins appear as one of the potential additional factors contributing to the cardiovascular risk in familial hypercholesterolemia. Specifically, the content of Apo M-SP1 in HDL3 has been directly associated with cholesterol efflux capacity. In addition, a coordinated decrease in the content of Apo L1 and LCAT in HDL3 has been related to the presence of corneal arcus and to bad prognosis in familial hypercholesterolemia patients after an acute ischemic event. In fact, HDL3 particles of familial hypercholesterolemia patients have diminished antioxidant and anti-inflammatory function. SUMMARY The identification of the specific changes in HDL-associated proteins that contribute to the increased cardiovascular risk of familial hypercholesterolemia patients could be useful for the development of novel therapeutic targets. These novel strategies, in combination with current lipid-lowering therapies, may help to reduce the residual risk found in these patients.
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Affiliation(s)
- Lina Badimon
- aCardiovascular Science Institute - ICCC, Biomedical Research Institute Sant Pau (IIB-Sant Pau) and CiberCV bCardiovascular Research Chair UAB, Barcelona, Spain
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15
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Evaluation of clinical and laboratory parameters used in the identification of index cases for genetic screening of familial hypercholesterolemia in Brazil. Atherosclerosis 2017; 263:257-262. [DOI: 10.1016/j.atherosclerosis.2017.06.917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/30/2017] [Accepted: 06/21/2017] [Indexed: 12/20/2022]
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16
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Abstract
PURPOSE OF REVIEW To review how leveraging familial hypercholesterolemia registries can impact molecular genetic research and precision medicine. RECENT FINDINGS Familial hypercholesterolemia is both much more common and more phenotypically heterogeneous than previously thought with some evidence for significant genotype to phenotype correlations. Genetic testing for familial hypercholesterolemia is becoming both more widely available and cheaper, spurring conversations about its clinical utility. SUMMARY In most countries, familial hypercholesterolemia is underdiagnosed and diagnosed later in life, often after the onset of coronary heart disease (CHD). Familial hypercholesterolemia is undertreated; low goal attainment and additional modifiable risk factors further increase CHD risk. Familial hypercholesterolemia epitomizes the goal of precision medicine to define a subset of individuals with a high risk of morbidity and mortality through genetic diagnosis to manage and treat the risk accordingly. Genetic cascade screening can be used to identify familial hypercholesterolemia patients at a younger age and start timely treatment to prevent CHD. Familial hypercholesterolemia registries are tools for clinical research and improving healthcare planning and patient care. As genotype and phenotype correlations in familial hypercholesterolemia become increasingly understood, this information will likely play a more important role in diagnosis and treatment especially as the cost of genetic testing continues to decline.
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Affiliation(s)
- Iris Kindt
- aThe FH Foundation, Pasadena, California, USA bFundacion Hipercolesterolemia Familiar, Madrid, Spain cDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University, Stanford University Falk Cardiovascular Research Center, Stanford, California, USA
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17
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Santos RD. Phenotype vs. genotype in severe familial hypercholesterolemia: what matters most for the clinician? Curr Opin Lipidol 2017; 28:130-135. [PMID: 28059950 DOI: 10.1097/mol.0000000000000391] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia is associated with a high lifetime risk of atherosclerotic cardiovascular disease (ASCVD). However, this risk is variable. This review evaluates recent evidence related to ASCVD risk stratification in familial hypercholesterolemia considering aspects of phenotype and genotype. RECENT FINDINGS The heterogeneity in clinical, laboratory characteristics, and in ASCVD risk in both homozygous and heterozygous familial hypercholesterolemia individuals in part can be attributed to the type of molecular defect. In most individuals with LDL cholesterol more than 190 mg/dl, a familial hypercholesterolemia-causing variant is not encountered, however, when present, a variant implicates an even higher ASCVD risk for such individuals. Previous ASCVD events, elevated blood lipoprotein(a), cutaneous markers of cholesterol deposit are among other factors that indicate a higher ASCVD risk in familial hypercholesterolemia individuals underlying a more severe form of the phenotype. SUMMARY Both clinical and genetic parameters help identify higher ASCVD risk among severe familial hypercholesterolemia individuals.
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Affiliation(s)
- Raul D Santos
- Lipid Clinic Heart Institute (InCor) University of Sao Paulo Medical School Hospital and Preventive Medicine Center and Cardiology Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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18
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Tada H, Kawashiri MA, Nohara A, Inazu A, Mabuchi H, Yamagishi M. Impact of clinical signs and genetic diagnosis of familial hypercholesterolaemia on the prevalence of coronary artery disease in patients with severe hypercholesterolaemia. Eur Heart J 2017; 38:1573-1579. [DOI: 10.1093/eurheartj/ehx004] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/03/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Masa-aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Atsushi Nohara
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Akihiro Inazu
- Department of Laboratory Science, Molecular Biochemistry and Molecular Biology, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan
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