1
|
Rallidis LS, Rizos CV, Papathanasiou KA, Liamis G, Skoumas I, Garoufi A, Kolovou G, Tziomalos K, Skalidis E, Kotsis V, Sfikas G, Doumas M, Anagnostis P, Lambadiari V, Giannakopoulou V, Kiouri E, Anastasiou G, Petkou E, Koutagiar I, Attilakos A, Kolovou V, Zacharis E, Antza C, Koumaras C, Boutari C, Liberopoulos E. Physical signs and atherosclerotic cardiovascular disease in familial hypercholesterolemia: the HELLAS-FH Registry. J Cardiovasc Med (Hagerstown) 2024; 25:370-378. [PMID: 38526957 DOI: 10.2459/jcm.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
AIMS Three physical signs, namely tendon xanthomas, corneal arcus and xanthelasma, have been associated with heterozygous familial hypercholesterolemia (heFH). The prevalence and clinical significance of these signs are not well established among contemporary heFH individuals. This study explored the frequency as well as the association of these physical signs with prevalent atherosclerotic cardiovascular disease (ASCVD) in heFH individuals. METHODS Data from the Hellenic Familial Hypercholesterolemia Registry were applied for this analysis. The diagnosis of heFH was based on the Dutch Lipid Clinic Network Score. Multivariate logistic regression analysis was conducted to examine the association of heFH-related physical signs with prevalent ASCVD. RESULTS Adult patients ( n = 2156, mean age 50 ± 15 years, 47.7% women) were included in this analysis. Among them, 14.5% had at least one heFH-related physical sign present. The prevalence of corneal arcus before the age of 45 years was 6.6%, tendon xanthomas 5.3%, and xanthelasmas 5.8%. Among physical signs, only the presence of corneal arcus before the age of 45 years was independently associated with the presence of premature coronary artery disease (CAD). No association of any physical sign with total CAD, stroke or peripheral artery disease was found. Patients with physical signs were more likely to receive higher intensity statin therapy and dual lipid-lowering therapy, but only a minority reached optimal lipid targets. CONCLUSION The prevalence of physical signs is relatively low in contemporary heFH patients. The presence of corneal arcus before the age of 45 years is independently associated with premature CAD.
Collapse
Affiliation(s)
- Loukianos S Rallidis
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - Christos V Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Konstantinos A Papathanasiou
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - George Liamis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Ioannis Skoumas
- 1 Cardiology Department of Athens Medical School, University of Athens, Hippokration Hospital, Athens
| | - Anastasia Garoufi
- Second Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, General Children's Hospital 'P. & A. Kyriakou', Athens
| | - Genovefa Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens
| | - Konstantinos Tziomalos
- 1 Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
| | | | - Vasileios Kotsis
- 3 Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki
| | - George Sfikas
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki
| | - Michalis Doumas
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki
| | | | - Vaia Lambadiari
- 2 Propaedeutic Internal Medicine Department and Diabetes Research Unit, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | | | - Estela Kiouri
- Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens
| | - Georgia Anastasiou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Ermioni Petkou
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina
| | - Iosif Koutagiar
- 1 Cardiology Department of Athens Medical School, University of Athens, Hippokration Hospital, Athens
| | - Achilleas Attilakos
- Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, C' Pediatrics Clinic, Attikon University General Hospital, Athens
| | - Vana Kolovou
- Cardiometabolic Center, Lipid Clinic, LA apheresis Unit, Metropolitan Hospital, Athens
| | | | - Christina Antza
- 3 Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki
| | - Charalambos Koumaras
- Department of Internal Medicine, 424 General Military Training Hospital, Thessaloniki
| | - Chrysoula Boutari
- Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki
| | - Evangelos Liberopoulos
- 1 Propaedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| |
Collapse
|
2
|
Katzmann JL, Laufs U. Liver transplantation for homozygous familial hypercholesterolemia: Cure for a genetic disease? Atherosclerosis 2023; 387:117337. [PMID: 37866977 DOI: 10.1016/j.atherosclerosis.2023.117337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Julius L Katzmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
3
|
März W, Scharnagl H, Kleber M, Silbernagel G, Nauck M, Müller-Wieland D, von Eckardstein A. [Laboratory diagnostics of lipid metabolism disorders]. Dtsch Med Wochenschr 2023; 148:e120-e146. [PMID: 37949074 PMCID: PMC10637831 DOI: 10.1055/a-1516-2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Clinically, disorders of lipid metabolism often remain without symptoms. Typical skin lesions, however, can be indicative. Secondary hyperlipoproteinemias (HLP) are more common than primary hyperlipoproteinemias; they can (partially) be improved by treating the underlying disease. Basic diagnostics consist of the determination of cholesterol, triglycerides, LDL cholesterol and HDL cholesterol. To exclude secondary HLP, glucose, HbA1C, TSH, transaminases, creatinine, urea, protein and protein in the urine are useful. Since virtually all routine methods for LDL-C are biased by high triglycerides, lipoprotein electrophoresis is indicated for triglycerides above 400 mg/dl (4.7 mmol/l). Primary HLPs have known or yet unknown genetic causes. Primary hyperlipidemias should be taken into consideration especially in young patients with an LDL cholesterol concentration are above 190 mg/dl (4.9 mmol/l) and/or triglycerides above 400 mg/dl (10 mmol/l) and secondary HLP (obesity, alcohol, diabetes mellitus, kidney disease) is excluded. The basic diagnostics is meaningfully extended by the measurement of lipoprotein (a) (Lp(a)). It is indicated in moderate and high risk of vascular disease, progression of atherosclerosis in "well-controlled" LDL cholesterol, familial clustering of atherosclerosis or high Lp(a), evidence for elevated Lp(a) coming from lipoprotein electrophoresis, aortic stenosis and in patients in whom statins have a poor effect. Genetic diagnostics needs to be considered if primary HLP is suspected. It is most frequently conducted for suspected familial hypercholesterolemia and has already been recommended in guidelines.
Collapse
Affiliation(s)
- Winfried März
- Korrespondenzadresse Univ. Prof. Dr. med. Winfried März SYNLAB AkademieP5,7D-68167 Mannheim+49/6 21/43 17 94 32+49/6 21/4 31 94 33
| | | | | | | | | | | | | |
Collapse
|
4
|
Marchal V, Souchon PF, Bednarek N, De Aquino A, Landais E, Doco-Fenzy M, Viguier M, Gusdorf L. Early childhood-onset cutaneous xanthomatosis revealing familial hypercholesterolemia. Ann Dermatol Venereol 2023; 150:238-240. [PMID: 37088684 DOI: 10.1016/j.annder.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/23/2022] [Accepted: 02/21/2023] [Indexed: 04/25/2023]
Affiliation(s)
- V Marchal
- Department of Dermatology, Reims University Hospital, Reims, France.
| | - P-F Souchon
- Department of Pediatrics, Reims University Hospital, Reims, France
| | - N Bednarek
- Department of Pediatrics, Reims University Hospital, Reims, France
| | - A De Aquino
- Department of Cardiology, Reims University Hospital, Reims, France
| | - E Landais
- Department of Genetics and EA3801 SFR CAP Santé, Reims University Hospital, Reims, France
| | - M Doco-Fenzy
- Department of Genetics and EA3801 SFR CAP Santé, Reims University Hospital, Reims, France
| | - M Viguier
- Department of Dermatology, Reims University Hospital, Reims, France
| | - L Gusdorf
- Department of Dermatology, Reims University Hospital, Reims, France
| |
Collapse
|
5
|
Allevi M, Sarnari S, Giulietti F, Spannella F, Di Pentima C, Sarzani R. Painful and recurring injection site reaction to alirocumab and evolocumab in a young woman with familial hypercholesterolemia and effective therapeutic alternative based on inclisiran: a case report. Front Cardiovasc Med 2023; 10:1181720. [PMID: 37424909 PMCID: PMC10326624 DOI: 10.3389/fcvm.2023.1181720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
A 28-year-old woman with autosomal dominant familial hypercholesterolemia (FH) with a probable coexistent polygenic contribution causing very high low-density lipoprotein-cholesterol (LDL-C) levels, started therapy with the proprotein convertase subtilisin/kexin type 9-inhibitor (PCSK9i) alirocumab, in addition to high-intensity statin plus ezetimibe. Forty-eight hours after the second injection of alirocumab, the patient developed a painful palpable injection site reaction (ISR) that recurred after the third administration of the drug. Treatment was then switched to evolocumab, another PCSK9i, but the patient had an ISR with similar features. The most conceivable cause of the ISR was a cell-mediated hypersensitivity reaction to polysorbate, an excipient contained in both drugs. Although ISR after PCSK9i administration is usually transient and does not compromise the continuation of treatment, in this case the recurrence of such side effect in an exacerbated way led to treatment withdrawal, with a subsequent re-exposure to increased cardiovascular (CV) risk. As soon as it became available in clinical practice, the patient started treatment with inclisiran, a small interfering RNA targeting hepatic PCSK9 synthesis. No adverse events were reported after inclisiran administration and LDL-C levels decreased significantly, confirming the evidence that this innovative approach to hypercholesterolemia is a safe and effective resource in patients at high CV risk who cannot achieve LDL-C goal with conventional lipid-lowering therapies and antibody-based PCSK9i.
Collapse
Affiliation(s)
- Massimiliano Allevi
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Silvia Sarnari
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| |
Collapse
|
6
|
Klose G. [Clinical presentation, diagnosis and therapy of familial hypercholesterolemia]. MMW Fortschr Med 2022; 164:48-53. [PMID: 36413295 DOI: 10.1007/s15006-022-1994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Gerald Klose
- Gemeinschaftspraxis, Praxen Dres. Beckenbauer & Maierhof, Am Markt 11, 28195, Bremen, Deutschland.
| |
Collapse
|
7
|
Gitt AK, Laufs U, März W, Paar WD, Bramlage P, Marx N, Parhofer KG. Hypercholesterolemia Diagnosis, Treatment Patterns, and 12-Month Target Achievement in Clinical Practice in Germany in Patients with Familial Hypercholesterolemia. J Clin Med 2022; 11:jcm11133810. [PMID: 35807095 PMCID: PMC9267207 DOI: 10.3390/jcm11133810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Familial hypercholesterolemia (FH) is a highly prevalent disorder and a risk factor for early coronary artery disease. The objective of this registry was to document the clinical characteristics of patients with definite FH in Germany and to document lipid profiles, lipid-lowering therapy, and lipid target achievement during longitudinal follow-up. Methods: HYDRA-FH was a national, prospective, multicenter, non-interventional registry conducted in 35 centers in Germany. Consecutive adult patients with definite FH were included (n = 241). Results: In the cross-sectional analysis (n = 233), lipid-lowering therapy involved statins (82.0%), ezetimibe (31.8%), and PCSK9 antibodies (18.5%); 11.2% of patients were receiving no lipid-lowering drugs. Median lipid levels were: low-density lipoprotein cholesterol (LDL-C) 134 mg/dL (3.5 mmol/L), high-density lipoprotein cholesterol (HDL-C) 48 mg/dL (1.2 mmol/L), triglycerides 160 mg/dL (1.9 mmol/L), total cholesterol 211 mg/dL (5.5 mmol/L). Values were above the normal threshold (150 mg/dL) for LDL-C in 72.9%, total cholesterol in 29.7%, and triglycerides in 45.0% of patients. After the 12-month follow-up (n = 145), only 17.2% had LDL-C < 70 mg/dL, and 20.7% had either LDL-C < 70 mg/dL or a reduction of ≥50% versus baseline. Conclusion: This study provides insight into the clinical characteristics and current treatment status of patients with FH in Germany. Many patients with FH do not achieve recommended lipid levels.
Collapse
Affiliation(s)
- Anselm K. Gitt
- Medical Clinic B, Department of Cardiology, Herzzentrum Ludwigshafen, Bremserstr. 79, 67117 Ludwigshafen, Germany;
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, University of Leipzig Medical Center, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Winfried März
- Synlab Academy, 68163 Mannheim, Germany;
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - W. Dieter Paar
- Medical Department, Sanofi-Aventis Deutschland GmbH, Lützowstr. 107, 10785 Berlin, Germany;
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstr. 20, 49661 Cloppenburg, Germany
- Correspondence:
| | - Nikolaus Marx
- Clinic for Cardiology, Angiology and Intensive Medicine, University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany;
| | - Klaus G. Parhofer
- Medical Clinic IV—Großhadern, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany;
| |
Collapse
|