1
|
Kavey REW. Myopathy in Statin-Treated Children and Adolescents: A Practical Approach. Curr Atheroscler Rep 2024:10.1007/s11883-024-01239-x. [PMID: 39316353 DOI: 10.1007/s11883-024-01239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE OF REVIEW This paper reviews the existing literature on statin-related myopathy in children and adolescents, to inform development of a practical management approach. RECENT FINDINGS Reports of statin treatment in the pediatric population revealed no evidence of muscle pathology, with asymptomatic elevation of creatine kinase(CK) levels and symptoms of muscle pain without CK elevation seen equally in subjects and controls in RCTs. By contrast, rare cases of rhabdomyolysis have now been documented in statin-treated children; this serious problem had never been previously reported. Statin-induced myopathy is rare in childhood so routine monitoring of CK levels is unnecessary in asymptomatic patients, reserved for those with muscle pain. Rare case reports of rhabdomyolysis in statin-treated children and adolescents suggest that parent and patient education on symptoms of adverse statin effects should include immediate physician contact with the appearance of dark urine, with or without muscle pain.
Collapse
Affiliation(s)
- Rae-Ellen W Kavey
- University of Rochester Medical Center, 1475 East Avenue, Rochester, NY, 14610, USA.
| |
Collapse
|
2
|
Cao J, Donato L, El-Khoury JM, Goldberg A, Meeusen JW, Remaley AT. ADLM Guidance Document on the Measurement and Reporting of Lipids and Lipoproteins. J Appl Lab Med 2024; 9:1040-1056. [PMID: 39225455 DOI: 10.1093/jalm/jfae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The accurate measurement of blood lipids and lipoproteins is crucial for the clinical management of atherosclerotic disease risk. Despite progress in standardization, there are still significant variations in pre-analytical requirements, methods, nomenclature, and reporting work flows. CONTENT The guidance document aims to improve standardization of clinical lipid testing work flows. It provides recommendations for the components of the lipid panel, fasting requirements, reporting of results, and specific recommendations for non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], apolipoprotein B (apo B), point-of-care lipid testing, and LDL subfraction testing. SUMMARY Lipid panels should always report non-HDL-C and LDL-C calculations if possible. Fasting is not routinely required except in specific cases. Modern equations should be utilized for LDL-C calculation. These equations allow for LDL-C reporting at elevated concentrations of triglycerides and obviate the need for direct measured LDL-C in most cases.
Collapse
Affiliation(s)
- Jing Cao
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Leslie Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Anne Goldberg
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
3
|
Tsai HH, Young JL, Cherny S, Ahmed CD, Khan SS, Duquette D. "I don't think people should die young": perspectives of parents with children diagnosed with familial hypercholesterolemia. J Community Genet 2024:10.1007/s12687-024-00725-8. [PMID: 39126536 DOI: 10.1007/s12687-024-00725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Familial Hypercholesterolemia (FH) is an inherited disorder that significantly increases an individual's risk of developing premature cardiovascular disease (CVD). Early intervention involving lifestyle modification and medication is crucial in preventing CVD. Prior studies have shown that lipid-lowering therapy in children is safe and effective. Despite FH being a treatable and manageable condition, the condition is still underdiagnosed and undertreated. Universal lipid screening (ULS) in children has been recommended by some medical experts in the United States as a strategy to identify cases of FH and maximize the benefits of early invention. However, lipid screening is not routinely offered in pediatric clinics. This study aimed to explore parental experience with FH diagnosis in their children, identify key facilitators and barriers in children's diagnosis and care, and examine parental perspectives on ULS in children in the United States. A total of fourteen semi-structured interviews were conducted with participants recruited through the Family Heart Foundation. Thematic analysis identified three key themes: role of family history in facilitating child's FH diagnosis, barriers and challenges in post-diagnosis care, and attitudes towards ULS in children. All participants supported ULS in children and emphasized the value of early diagnosis and treatment for FH. However, a lack of guidance or referral after the child's diagnosis was a concern raised by many participants. This underscores the need for accessible and comprehensive care amid ongoing efforts to increase pediatric diagnosis of FH.
Collapse
Affiliation(s)
- Hsiao H Tsai
- Northwestern University, 645 N Michigan Ave Suite 630, Chicago, IL, 60611, USA
- Rady Children's Hospital - San Diego, 3020 Children's Way, San Diego, CA, 92123, USA
| | - Jennifer L Young
- Northwestern University, 645 N Michigan Ave Suite 630, Chicago, IL, 60611, USA.
| | - Sara Cherny
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | | | - Sadiya S Khan
- Northwestern Medicine, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Debra Duquette
- Northwestern University, 645 N Michigan Ave Suite 630, Chicago, IL, 60611, USA
| |
Collapse
|
4
|
Lokkesmoe R, Hamilton L. The Role of Reverse Cascade Screening in Children with Familial Hypercholesterolemia: A Literature Review and Analysis. Curr Atheroscler Rep 2024; 26:427-433. [PMID: 38888696 DOI: 10.1007/s11883-024-01211-9] [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] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW Familial Hypercholesterolemia (FH) is a common genetic disorder characterized by lifelong elevation of severely elevated plasma low-density lipoprotein cholesterol. Atherosclerotic cardiovascular disease (ASCVD) risk accelerates after age 20. Early diagnosis allows for treatment of children with FH and creates an opportunity to identify affected relatives through reverse cascade screening (RCS). Historically, cascade screening has had little impact on identifying individuals with FH. RECENT FINDINGS Universal cholesterol screening (UCS) to identify youth with FH, beginning at 9-11 years-of-age, is currently recommended in the U.S. The European Atherosclerosis Society has called for UCS worldwide, emphasizing the need for educational programs to increase awareness amongst healthcare professions. Underdiagnoses and undertreatment of FH remain high. Improved rates of UCS and a systematic approach to RCS are needed. The absence of a coordinated RCS program limits the benefits of UCS. Further research is needed to identify barriers to cholesterol screening in youth.
Collapse
Affiliation(s)
- Ryan Lokkesmoe
- Cook Children's Medical Center, Department of Endocrinology, 801 7th Ave, Fort Worth, TX, 76104, USA.
| | - Luke Hamilton
- Cook Children's Medical Center, Department of Research and Endocrinology, Fort Worth, TX, USA
| |
Collapse
|
5
|
Carboni J, Thomas E, Gipson DS, Brady TM, Srivastava T, Selewski DT, Greenbaum LA, Wang CS, Dell KM, Kaskel F, Massengill S, Reidy K, Tran CL, Trachtman H, Lafayette R, Almaani S, Hingorani S, Gbadegesin R, Gibson KL, Sethna CB. Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome. Pediatr Nephrol 2024; 39:2161-2170. [PMID: 38319465 DOI: 10.1007/s00467-024-06301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the current study, longitudinal BP and lipid measurements were examined in a NEPTUNE cohort of children with newly diagnosed nephrotic syndrome (cNEPTUNE). We hypothesized that hypertensive BP and dyslipidemia would persist in children with nephrotic syndrome, regardless of steroid treatment response. METHODS A multi-center longitudinal observational analysis of data obtained from children < 19 years of age with new onset nephrotic syndrome enrolled in the Nephrotic Syndrome Study Network (cNEPTUNE) was conducted. BP and lipid data were examined over time stratified by disease activity and steroid exposure. Generalized estimating equation regressions were used to find determinants of hypertensive BP and dyslipidemia. RESULTS Among 122 children, the prevalence of hypertensive BP at any visit ranged from 17.4% to 57.4%, while dyslipidemia prevalence ranged from 40.0% to 96.2% over a median of 30 months of follow-up. Hypertensive BP was found in 46.2% (116/251) of study visits during active disease compared with 31.0% (84/271) of visits while in remission. Dyslipidemia was present in 88.2% (120/136) of study visits during active disease and in 66.0% (101/153) while in remission. Neither dyslipidemia nor hypertensive BP were significantly different with/without medication exposure (steroids and/or CNI). In regression analysis, male sex and urine protein:creatinine ratio (UPC) were significant determinants of hypertensive BP over time, while eGFR was found to be a determinant of dyslipidemia over time. CONCLUSIONS Results demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment.
Collapse
Affiliation(s)
- Johnathon Carboni
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
| | - Elizabeth Thomas
- Division of Nephrology, Department of Pediatrics, Dell Children's Medical Center, University of Texas, Austin, TX, USA
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Tammy M Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tarak Srivastava
- Section of Nephrology, Children's Mercy Hospital and University of Missouri, Kansas City, MO, USA
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Larry A Greenbaum
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chia-Shi Wang
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Katherine M Dell
- Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children's, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Frederick Kaskel
- Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Susan Massengill
- Division of Nephrology, Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, USA
| | - Kimberly Reidy
- Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Cheryl L Tran
- Division of Pediatric Nephrology, Department of Pediatrics and Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Richard Lafayette
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Salem Almaani
- Division of Nephrology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sangeeta Hingorani
- Division of Nephrology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rasheed Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA
| | - Keisha L Gibson
- Division of Pediatric Nephrology, UNC Kidney Center, Chapel Hill, North Carolina, USA
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA.
| |
Collapse
|
6
|
Gidding SS, Ballantyne CM, Cuchel M, de Ferranti S, Hudgins L, Jamison A, McGowan MP, Peterson AL, Steiner RD, Uveges MK, Wang Y. It is Time to Screen for Homozygous Familial Hypercholesterolemia in the United States. Glob Heart 2024; 19:43. [PMID: 38708402 PMCID: PMC11067975 DOI: 10.5334/gh.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Homozygous familial hypercholesterolemia (HoFH) is an ultra-rare inherited condition that affects approximately one in 300,000 people. The disorder is characterized by extremely high, life-threatening levels of low-density lipoprotein (LDL) cholesterol from birth, leading to significant premature cardiovascular morbidity and mortality, if left untreated. Homozygous familial hypercholesterolemia is severely underdiagnosed and undertreated in the United States (US), despite guidelines recommendations for universal pediatric lipid screening in children aged 9-11. Early diagnosis and adequate treatment are critical in averting premature cardiovascular disease in individuals affected by HoFH. Yet, an unacceptably high number of people living with HoFH remain undiagnosed, misdiagnosed, and/or receive a late diagnosis, often after a major cardiovascular event. The emergence of novel lipid-lowering therapies, along with the realization that diagnosis is too often delayed, have highlighted an urgency to implement policies that ensure timely detection of HoFH in the US. Evidence from around the world suggests that a combination of universal pediatric screening and cascade screening strategies constitutes an effective approach to identifying heterozygous familial hypercholesterolemia (HeFH). Nevertheless, HoFH and its complications manifest much earlier in life compared to HeFH. To date, little focus has been placed on the detection of HoFH in very young children and/or infants. The 2023 Updated European Atherosclerosis Society Consensus Statement on HoFH has recommended, for the first time, broadening pediatric guidelines to include lipid screening of newborn infants. Some unique aspects of HoFH need to be considered before implementing newborn screening. As such, insights from pilot studies conducted in Europe may provide some preliminary guidance. Our paper proposes a set of actionable measures that states can implement to reduce the burden of HoFH. It also outlines key research and policy gaps that need to be addressed in order to pave the way for universal newborn screening of HoFH in the US.
Collapse
Affiliation(s)
| | | | - Marina Cuchel
- Perelman School of Medicine, University of Pennsylvania, US
| | | | | | | | - Mary P. McGowan
- Family Heart Foundation, US
- Dartmouth Hitchcock Medical Center, US
| | - Amy L. Peterson
- University of Wisconsin School of Medicine and Public Health, US
| | - Robert D. Steiner
- Leadiant, Mirum, PTC-Consultant, PreventionGenetics, part of Exact Sciences-Employee with equity, University of Wisconsin School of Medicine and Public Health, US
| | | | | |
Collapse
|
7
|
Zhang Y, de Ferranti SD, Moran AE. Genetic testing for familial hypercholesterolemia. Curr Opin Lipidol 2024; 35:93-100. [PMID: 38299384 PMCID: PMC10932851 DOI: 10.1097/mol.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Despite familial hypercholesterolemia (FH) being the most common genetic cause of cardiovascular disease (CVD), genetic testing is rarely utilized in the US. This review summarizes what is known about the clinical utility of genetic testing and its role in the diagnosis and screening of FH. RECENT FINDINGS The presence of an FH-causative variant is associated with a substantially higher risk of CVD, even when low-density lipoprotein cholesterol (LDL-C) levels are only modestly elevated. Genetic testing can facilitate the identification of FH cases who may be missed by clinical diagnostic criteria, improve risk stratification beyond LDL-C and family history, guide treatment decisions, and improve treatment initiation and adherence. Genetic testing can be incorporated into FH screening and diagnosis algorithms, including cascade, targeted, and universal screening. Integrating genetic testing into cascade screening can enhance the effectiveness of the process. Several models of universal FH screening with coordinated genetic and lipid testing are feasible and effective. SUMMARY More systematic integration of genetic testing into FH diagnosis and screening can significantly reduce the burden of this condition through early detection and treatment. Further pragmatic implementation studies are needed to determine how to more effectively and affordably integrate genetic testing into clinical lipid screening programs.
Collapse
Affiliation(s)
- Yiyi Zhang
- Division of General Medicine, Columbia University, New York, NY
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Andrew E. Moran
- Division of General Medicine, Columbia University, New York, NY
| |
Collapse
|
8
|
Zhang Y, Dron JS, Bellows BK, Khera AV, Liu J, Balte PP, Oelsner EC, Amr SS, Lebo MS, Nagy A, Peloso GM, Natarajan P, Rotter JI, Willer C, Boerwinkle E, Ballantyne CM, Lutsey PL, Fornage M, Lloyd-Jones DM, Hou L, Psaty BM, Bis JC, Floyd JS, Vasan RS, Heard-Costa NL, Carson AP, Hall ME, Rich SS, Guo X, Kazi DS, de Ferranti SD, Moran AE. Familial Hypercholesterolemia Variant and Cardiovascular Risk in Individuals With Elevated Cholesterol. JAMA Cardiol 2024; 9:263-271. [PMID: 38294787 PMCID: PMC10831623 DOI: 10.1001/jamacardio.2023.5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024]
Abstract
Importance Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified. Objective To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (≥190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults. Design, Setting, and Participants A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023. Exposures LDL-C, cumulative past LDL-C, FH variant status. Main Outcomes and Measures Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults. Results Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3%) and in 33 individuals with severely elevated LDL-C (2.5%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95% CI, 1.4-6.0) and 2.6 (95% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant. Conclusions and Relevance In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.
Collapse
Affiliation(s)
- Yiyi Zhang
- Division of General Medicine, Columbia University, New York, New York
| | - Jacqueline S. Dron
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | | | - Amit V. Khera
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Pallavi P. Balte
- Division of General Medicine, Columbia University, New York, New York
| | | | - Sami Samir Amr
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Matthew S. Lebo
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Anna Nagy
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Cristen Willer
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Human Genetics, University of Michigan, Ann Arbor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | | | - Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston
| | | | - Lifang Hou
- Northwestern University, Chicago, Illinois
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Ramachandran S. Vasan
- The Framingham Heart Study, Framingham, Massachusetts
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Nancy L. Heard-Costa
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Dhruv S. Kazi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew E. Moran
- Division of General Medicine, Columbia University, New York, New York
| |
Collapse
|
9
|
Jones LK, Romagnoli KM, Schubert TJ, Clegg K, Kirchner HL, Hu Y, Cawley D, Norelli V, Williams MS, Gidding SS, Rahm AK. Using implementation science to develop a familial hypercholesterolemia screening program in primary care: The CARE-FH study. J Clin Lipidol 2024; 18:e176-e188. [PMID: 38228467 PMCID: PMC11069448 DOI: 10.1016/j.jacl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND We designed the Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia (CARE-FH) clinical trial to improve FH screening in primary care and facilitate guideline-based care. OBJECTIVE The goal was to incorporate perspectives from end-users (healthcare system leaders, primary care clinicians, cardiologists, genetic counselors, nurses, and clinic staff) and improve translation of screening guidance into practice. METHODS We partnered with end-users to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically actionable strategies at the patient-, clinician-, and system-level to be deployed as a package in the CARE-FH clinical trial. Methods informed by implementation science and human centered design included: contextual inquiries, surveys, and deliberative engagement sessions. RESULTS Screening for FH occurred rarely in primary care, and then only after a cardiovascular event or sometimes due to a family history of high cholesterol or early heart attack. Surveys suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers to screening include insufficient time at patient encounters to screen, cost and convenience of testing for patients, and knowledge regarding causes of dyslipidemia. Facilitators included clear guidance on screening criteria and new therapies to treat FH. These results led to the development of multilevel strategies that were presented to end-users, modified, and then pilot tested in one primary care clinic. CONCLUSIONS A refined implementation strategy package for FH screening was created with a goal of improving FH awareness, identification, and initiation of guideline-based care. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/study/NCT05284513?id=NCT05284513&rank=1 Unique Identifier: NCT05284513.
Collapse
Affiliation(s)
- Laney K. Jones
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
- Heart and Vascular Institute, Geisinger, Danville, PA 17822, USA
| | - Katrina M. Romagnoli
- Department of Population Health Sciences, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Tyler J. Schubert
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA
| | - Katarina Clegg
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA
| | - H. Lester Kirchner
- Department of Population Health Sciences, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Yirui Hu
- Department of Population Health Sciences, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Dylan Cawley
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Victoria Norelli
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Marc S. Williams
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Samuel S. Gidding
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
| | - Alanna K. Rahm
- Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA
| |
Collapse
|
10
|
Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder RS, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macıas JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
Collapse
|
11
|
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
|
12
|
Liebeskind A, Wilson DP. Cholesterol screening and intervention in youth - It's time to move on. J Clin Lipidol 2023; 17:573-576. [PMID: 37777471 DOI: 10.1016/j.jacl.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Ann Liebeskind
- Vice President, Foundation of the National Lipid Association, Adjunct Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health, Lipidology, Mobile Health Team Complex Lipids Clinic, Neenah and Wauwatosa, WI, United States
| | - Don P Wilson
- Cook Children's Medical Center, Diplomate, American Board of Clinical Lipidology, Endowed Chair, Cardiovascular Health and Risk Prevention, Pediatric Endocrinology and Diabetes, Fort Worth, TX, United States.
| |
Collapse
|
13
|
Kim GK, Yee JK, Bansal N. Algorithms for Treating Dyslipidemia in Youth. Curr Atheroscler Rep 2023; 25:495-507. [PMID: 37523052 DOI: 10.1007/s11883-023-01122-1] [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] [Accepted: 06/16/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW The goal of this article is to review algorithms for treating dyslipidemia in youth, discuss pitfalls, propose enhanced algorithms to address pitfalls, and consider future directions. RECENT FINDINGS The presence of modifiable and non-modifiable cardiovascular disease (CVD) risk factors during childhood is associated with CVD-related events in adulthood. Recent data has shown that childhood initiation of statin therapy in youth < 18 years of age with familial hypercholesterolemia reduces the risk of adult CVD. However, pediatric dyslipidemia remains undertreated in part due to a lack of primary health care providers with adequate understanding of screening guidelines and pediatric lipidologists with experience in treatment and follow-up of this unique population. Management algorithms have been published by the National Heart, Lung, and Blood Institute and American Heart Association as tools to empower clinicians to manage dyslipidemia. We propose enhanced algorithms, which incorporate recently approved pharmacotherapy to address the management gaps. Future algorithms based upon clinical risk scores may enhance treatment and improve outcomes. Algorithms for dyslipidemia management which target youth < 18 years of age are tools which empower clinicians to manage dyslipidemia in this unique population. Enhanced algorithms may help address pitfalls. We acknowledge the need for further risk assessment tools in pediatrics for tailored dyslipidemia management.
Collapse
Affiliation(s)
- Grace K Kim
- Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Ste 1020, Houston, TX, 77030, USA
| | - Jennifer K Yee
- Division of Endocrinology, Department of Pediatrics, Harbor-UCLA Medical Center, The Lundquist Institute of Biomedical Innovation at Harbor-UCLA, Torrance, CA, 90509, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90509, USA
| | - Nidhi Bansal
- Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Ste 1020, Houston, TX, 77030, USA.
| |
Collapse
|
14
|
Genovesi S, Giussani M, Lieti G, Orlando A, Patti I, Parati G. Evidence and Uncertainties on Lipoprotein(a) as a Marker of Cardiovascular Health Risk in Children and Adolescents. Biomedicines 2023; 11:1661. [PMID: 37371756 PMCID: PMC10295837 DOI: 10.3390/biomedicines11061661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) is made up of apoprotein(a) (apo(a)) and an LDL-like particle. The LPA gene encodes apo(a) and thus determines the characteristics and amount of apo(a) and Lp(a). The proportion of Lp(a) in each individual is genetically determined and is only minimally modifiable by the environment or diet. Lp(a) has important pro-atherosclerotic and pro-inflammatory effects. It has been hypothesized that Lp(a) also has pro-coagulant and antifibrinolytic actions. For these reasons, high Lp(a) values are an important independent risk factor for cardiovascular disease and calcific aortic valve stenosis. Numerous studies have been performed in adults about the pathophysiology and epidemiology of Lp(a) and research is under way for the development of drugs capable of reducing Lp(a) plasma values. Much less information is available regarding Lp(a) in children and adolescents. The present article reviews the evidence on this topic. The review addresses the issues of Lp(a) changes during growth, the correlation between Lp(a) values in children and those in their parents, and between Lp(a) levels in children, and the presence of cardiovascular disease in the family. Gaining information on these points is particularly important for deciding whether Lp(a) assay may be useful for defining the cardiovascular risk in children, in order to plan a prevention program early.
Collapse
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (G.L.); (I.P.); (G.P.)
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy; (M.G.); (A.O.)
| | - Marco Giussani
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy; (M.G.); (A.O.)
| | - Giulia Lieti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (G.L.); (I.P.); (G.P.)
| | - Antonina Orlando
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy; (M.G.); (A.O.)
| | - Ilenia Patti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (G.L.); (I.P.); (G.P.)
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (G.L.); (I.P.); (G.P.)
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy; (M.G.); (A.O.)
| |
Collapse
|
15
|
Hyperlipidemia and Cardiovascular Risk in Children and Adolescents. Biomedicines 2023; 11:biomedicines11030809. [PMID: 36979789 PMCID: PMC10045454 DOI: 10.3390/biomedicines11030809] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) represents the major cause of morbidity and mortality worldwide. The onset of the atherosclerosis process occurs during childhood and adolescence, subsequently leading to the onset of cardiovascular disease as young adults. Several cardiovascular risk factors can be identified in children and adolescents; however, hyperlipidemia, in conjunction with the global obesity epidemic, has emerged as the most prevalent, playing a key role in the development of ASCVD. Therefore, screening for hyperlipidemia is strongly recommended to detect high-risk children presenting with these disorders, as these patients deserve more intensive investigation and intervention. Treatment should be initiated as early as possible in order to reduce the risk of future ASCVD. In this review, we will discuss lipid metabolism and hyperlipidemia, focusing on correlations with cardiovascular risk and screening and therapeutic management to reduce or almost completely avoid the development of ASCVD.
Collapse
|
16
|
de Boer LM, Hutten BA, Zwinderman AH, Wiegman A. Lipoprotein(a) levels in children with suspected familial hypercholesterolaemia: a cross-sectional study. Eur Heart J 2022; 44:1421-1428. [PMID: 36382390 PMCID: PMC10119030 DOI: 10.1093/eurheartj/ehac660] [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: 02/15/2022] [Revised: 09/14/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Familial hypercholesterolaemia (FH) predisposes children to the early initiation of atherosclerosis and is preferably diagnosed by DNA analysis. Yet, in many children with a clinical presentation of FH, no mutation is found. Adult data show that high levels of lipoprotein(a) [Lp(a)] may underlie a clinical presentation of FH, as the cholesterol content of Lp(a) is included in conventional LDL cholesterol measurements. As this is limited to adult data, Lp(a) levels in children with and without (clinical) FH were evaluated. METHODS AND RESULTS Children were eligible if they visited the paediatric lipid clinic (1989-2020) and if Lp(a) measurement and DNA analysis were performed. In total, 2721 children (mean age: 10.3 years) were included and divided into four groups: 1931 children with definite FH (mutation detected), 290 unaffected siblings/normolipidaemic controls (mutation excluded), 108 children with probable FH (clinical presentation, mutation not detected), and 392 children with probable non-FH (no clinical presentation, mutation not excluded). In children with probable FH, 32% were found to have high Lp(a) [geometric mean (95% confidence interval) of 15.9 (12.3-20.6) mg/dL] compared with 10 and 10% [geometric means (95% confidence interval) of 11.5 (10.9-12.1) mg/dL and 9.8 (8.4-11.3) mg/dL] in children with definite FH (P = 0.017) and unaffected siblings (P = 0.002), respectively. CONCLUSION Lp(a) was significantly higher and more frequently elevated in children with probable FH compared with children with definite FH and unaffected siblings, suggesting that high Lp(a) may underlie the clinical presentation of FH when no FH-causing mutation is found. Performing both DNA analysis and measuring Lp(a) in all children suspected of FH is recommended to assess possible LDL cholesterol overestimation related to increased Lp(a).
Collapse
Affiliation(s)
- Lotte M de Boer
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, TheNetherlands.,Pediatrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, TheNetherlands
| | - Barbara A Hutten
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, TheNetherlands.,Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, TheNetherlands.,Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Albert Wiegman
- Pediatrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, TheNetherlands.,Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Perioperative Management and Clinical Outcomes of Liver Transplantation for Children with Homozygous Familial Hypercholesterolemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101430. [PMID: 36295590 PMCID: PMC9607350 DOI: 10.3390/medicina58101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Liver transplantation (LT) has been accepted as a life-saving option as a last resort for children with homozygous familial hypercholesterolemia (HoFH). Perioperative management of LT for HoFH poses extra challenges for clinicians largely due to premature atherosclerotic cardiovascular diseases (ASCVDs). We aimed to analyze our data of pediatric LT recipients with HoFH, with special attention paid to perioperative management and clinical outcomes. Materials and Methods: After obtaining approval from the local ethics committee, the clinical data of pediatric patients with HoFH who underwent LT at our institution between January 2014 and February 2021 were retrospectively studied. Results: Six pediatric LT recipients with HoFH were included in the analysis. Although ASCVDs were common before LT, all children with HoFH survived the perioperative period without in-hospital mortality. However, one patient experienced acute myocardial infarction two months following LT and was successfully treated with medical interventions. Post-LT metabolic improvement was shown by declines in serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in the early post-LT period (for TC: 14.7 ± 3.2 mmol/L vs. 5.5 ± 1.8 mmol/L, p < 0.001; for LDL-C: 10.6 ± 2.2 mmol/L vs. 3.6 ± 1.2 mmol/L, p < 0.001, respectively) and at the last follow-up (for TC: 14.7 ± 3.2 mmol/L vs. 4.5 ± 0.9 mmol/L, p = 0.001; for LDL-C: 10.6 ± 2.2 mmol/L vs. 2.8 ± 0.6 mmol/L, p = 0.001, respectively). Dietary restrictions could be lifted after LT. However, three patients required restarting lipid-lowering therapy after LT due to suboptimal LDL-C levels and progression of ASCVDs. Conclusions: Our data suggest that LT can be a safe and feasible therapeutic option for well-selected patients with HoFH, offering relaxed dietary restrictions and remarkable reductions in LDL-C levels. However, concerns remain regarding progression of ASCVDs after LT.
Collapse
|
18
|
Horton AE, Martin AC, Srinivasan S, Justo RN, Poplawski NK, Sullivan D, Brett T, Chow CK, Nicholls SJ, Pang J, Watts GF. Integrated guidance to enhance the care of children and adolescents with familial hypercholesterolaemia: Practical advice for the community clinician. J Paediatr Child Health 2022; 58:1297-1312. [PMID: 35837752 PMCID: PMC9545564 DOI: 10.1111/jpc.16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/17/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
Abstract
Familial hypercholesterolaemia (FH) is a highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol (LDL-C) concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). At a prevalence of 1:250 individuals, with over 90% undiagnosed, recent estimates suggest that there are approximately 22 000 children and adolescents with FH in Australia and New Zealand. However, the overwhelming majority remain undetected and inadequately treated until adulthood or after their first cardiac event. The guidance in this paper aims to increase awareness about paediatric FH and provide practical advice for the diagnosis and management of FH in children and adolescents. Recommendations are given on the detection, diagnosis, assessment and management of FH in children and adolescents. Recommendations are also made on genetic testing, including counselling and the potential for universal screening programmes. Practical guidance on management includes treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-C lowering therapies, including statins, ezetimibe, PCSK9 inhibitors and lipoprotein apheresis. Models of care for FH need to be adapted to local and regional health care needs and available resources. Targeting the detection of FH as a priority in children and young adults has the potential to alter the natural history of atherosclerotic cardiovascular disease and recognise the promise of early detection for improving long-term health outcomes. A comprehensive implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all families with or at risk of FH.
Collapse
Affiliation(s)
- Ari E Horton
- Monash Heart and Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Andrew C Martin
- Department General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Robert N Justo
- Department of Paediatric Cardiology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tom Brett
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Cardiovascular Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen J Nicholls
- Monash Heart and Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
19
|
Rutkowska L, Sałacińska K, Salachna D, Matusik P, Pinkier I, Kępczyński Ł, Piotrowicz M, Starostecka E, Lewiński A, Gach A. Identification of New Genetic Determinants in Pediatric Patients with Familial Hypercholesterolemia Using a Custom NGS Panel. Genes (Basel) 2022; 13:genes13060999. [PMID: 35741760 PMCID: PMC9223034 DOI: 10.3390/genes13060999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
The most common form of inherited lipid disorders is familial hypercholesterolemia (FH). It is characterized primarily by high concentrations of the clinical triad of low-density lipoprotein cholesterol, tendon xanthomas and premature CVD. The well-known genetic background are mutations in LDLR, APOB and PCSK9 gene. Causative mutations can be found in 60−80% of definite FH patients and 20−30% of those with possible FH. Their occurrence could be attributed to the activity of minor candidate genes, whose causal mechanism has not been fully discovered. The aim of the conducted study was to identify disease-causing mutations in FH-related and candidate genes in pediatric patients from Poland using next generation sequencing (NGS). An NGS custom panel was designed to cover 21 causative and candidate genes linked to primary dyslipidemia. Recruitment was performed using Simon Broome diagnostic criteria. Targeted next generation sequencing was performed on a MiniSeq sequencer (Illumina, San Diego, CA, USA) using a 2 × 150 bp paired-end read module. Sequencing data analysis revealed pathogenic and possibly pathogenic variants in 33 out of 57 studied children. The affected genes were LDLR, APOB, ABCG5 and LPL. A novel pathogenic 7bp frameshift deletion c.373_379delCAGTTCG in the exon 4 of the LDLR gene was found. Our findings are the first to identify the c.373_379delCAGTTCG mutation in the LDLR gene. Furthermore, the double heterozygous carrier of frameshift insertion c.2416dupG in the LDLR gene and missense variant c.10708C>T in the APOB gene was identified. The c.2416dupG variant was defined as pathogenic, as confirmed by its cosegregation with hypercholesterolemia in the proband’s family. Although the APOB c.10708C>T variant was previously detected in hypercholesterolemic patients, our data seem to demonstrate no clinical impact. Two missense variants in the LPL gene associated with elevated triglyceride plasma level (c.106G>A and c.953A>G) were also identified. The custom NGS panel proved to be an effective research tool for identifying new causative aberrations in a genetically heterogeneous disease as familial hypercholesterolemia (FH). Our findings expand the spectrum of variants associated with the FH loci and will be of value in genetic counseling among patients with the disease.
Collapse
Affiliation(s)
- Lena Rutkowska
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
- Correspondence: (L.R.); (A.L.); (A.G.)
| | - Kinga Sałacińska
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Dominik Salachna
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Łukasz Kępczyński
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Małgorzata Piotrowicz
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Ewa Starostecka
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence: (L.R.); (A.L.); (A.G.)
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
- Correspondence: (L.R.); (A.L.); (A.G.)
| |
Collapse
|
20
|
Is Liver Transplant Curative in Homozygous Familial Hypercholesterolemia? A Review of Nine Global Cases. Adv Ther 2022; 39:3042-3057. [PMID: 35471728 PMCID: PMC9122866 DOI: 10.1007/s12325-022-02131-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Homozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening, inherited condition characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C). Patients are at high risk of atherosclerotic cardiovascular disease, adverse cardiovascular events, and associated early mortality. Liver transplant is sometimes used with curative intent. The objective of the current case series was to evaluate the follow-up of a range of patients who have undergone liver transplant for the treatment of HoFH. METHODS Patients with clinical and/or genetic diagnoses of HoFH were treated according to local practices in four units in Europe and the Middle East. All patients underwent liver transplantation. Baseline and long-term follow-up data were collected, including LDL-C levels, DNA mutations, lipid-lowering medications, and complications due to surgery and immunosuppressive therapy. RESULTS Nine patients were included with up to 22 years' follow-up (mean ± SD 11.7 ± 11.7 years; range 0.5-28 years). Three of the patients died as a result of complications of transplant surgery (mortality rate 33%). Among the surviving six patients, four required continued lipid-lowering therapy (LLT) to maintain LDL-C levels and two patients show signs of increasing LDL-C levels that require management. One case (11%) required two consecutive transplants to achieve a viable graft and is awaiting a third transplant because of graft failure. CONCLUSIONS Liver transplant did not enable attainment of recommended LDL-C targets in most patients with HoFH, and the majority of patients still required post-transplant LLT. Liver transplant was not curative in most of the patients with HoFH followed. Guidelines suggest that transplant is a treatment of last resort if contemporary treatments are not available or possible.
Collapse
|
21
|
A Selective Screening Strategy Performed in Pre-School Children and Siblings to Detect Familial Hypercholesterolemia. CHILDREN 2022; 9:children9050590. [PMID: 35626767 PMCID: PMC9140124 DOI: 10.3390/children9050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/02/2022]
Abstract
(1) Background: Familial hypercholesterolemia (FH), a most common genetic disorder, is underdiagnosed and untreated, especially in children. Individuals with heterozygous familial hypercholesterolemia mostly present without clinical symptoms and are not informed about their high risk for myocardial infarction. Early diagnosis and treatment can prevent premature atherosclerosis and cardiovascular events in patients with FH. The aim was to evaluate the detection rate of pre-school children with FH at school doctor visits in Vienna and, moreover, to examine the frequency of FH identified in the children’s siblings by this type of screening. (2) Methods: The selective FH- screening was implemented at the school enrolment examinations in the public primary schools of Vienna. The study period included the school years starting in 2017 to 2020. FH was suspected if a questionnaire on hypercholesterolemia, or cardiovascular events in the family history or on the presence of xanthomas or xanthelasma, was positive. Subsequently, lipid testing was performed on pre-school children and their siblings and elevated lipid screening was defined as either positive by LDL-C ≥ 160 mg/dL and/or non-HDL-C ≥ 190 mg/dL or as borderline by LDL-C ≥ 130 mg/dL and/or non-HDL-C ≥ 160 mg/dL. (3) Results: 66,108 pre-school children participated in the school enrolment examination in 868 public elementary schools in Vienna. In 512 (4%) children, the questionnaire caused suspicion of FH. 344 families agreed their participation in the study. Out of 344 (52% male) tested pre-school children, 20 individuals (40% male) had elevated blood lipid levels with a mean LDL-C of 155 ± 29 mg/dL and a non-HDL-C of 180 ± 24 mg/dL. Out of 291 (44% male) tested siblings, 17 individuals (41% male) showed elevated lipids with a mean LDL-C of 144 ± 19 mg/dL, and a non-HDL-C of 174 ± 19 mg/dL. (4) Conclusions: Screening is the key for early diagnosis and treatment of FH. We have implemented a pre-school screening strategy in cooperation with school physicians. We could identify 20 pre-school children and 17 siblings with an elevated lipid screening test. Full implementation of FH-screening in the pre-school examination visits in Vienna would help to detect high-risk children.
Collapse
|
22
|
Sanin V, Schmieder R, Ates S, Schlieben LD, Wiehler J, Sun R, Decker M, Sander M, Holdenrieder S, Kohlmayer F, Friedmann A, Mall V, Feiler T, Dreßler A, Strom TM, Prokisch H, Meitinger T, von Scheidt M, Koenig W, Leipold G, Schunkert H. Population-based screening in children for early diagnosis and treatment of familial hypercholesterolemia: design of the VRONI study. MED GENET-BERLIN 2022; 34:41-51. [PMID: 38836010 PMCID: PMC11006262 DOI: 10.1515/medgen-2022-2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/10/2022] [Indexed: 06/06/2024]
Abstract
Familial hypercholesterolemia (FH) is the most frequent monogenic disorder (prevalence 1:250) in the general population. Early diagnosis during childhood enables pre-emptive treatment, thus reducing the risk of severe atherosclerotic manifestations later in life. Nonetheless, FH screening programs are scarce. VRONI offers all children aged 5-14 years in Bavaria a FH screening in the context of regular pediatric visits. LDL-cholesterol (LDL-C) is measured centrally, followed by genetic analysis for FH if exceeding the age-specific 95th percentile (130 mg/dl, 3.34 mmol/l). Children with FH pathogenic variants are treated by specialized pediatricians and offered a FH-focused training course by a qualified training center. Reverse cascade screening is recommended for all first-degree relatives. VRONI aims to prove the feasibility of a population-based FH screening in children and to lay the foundation for a nationwide screening program.
Collapse
Affiliation(s)
- Veronika Sanin
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - Raphael Schmieder
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - Sara Ates
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - Lea Dewi Schlieben
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Neurogenomics, Department Computational Health, Helmholtz Zentrum München, Munich, Germany
| | - Jens Wiehler
- BioM Biotech Cluster Development GmbH, Martinsried, Germany
| | - Ruoyu Sun
- BioM Biotech Cluster Development GmbH, Martinsried, Germany
| | - Manuela Decker
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - Michaela Sander
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | - Anna Friedmann
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Germany
| | - Volker Mall
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Germany
| | - Therese Feiler
- Department of Systematic Theology and Ethics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Arne Dreßler
- Department of Systematic Theology and Ethics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tim M Strom
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - Holger Prokisch
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Neurogenomics, Department Computational Health, Helmholtz Zentrum München, Munich, Germany
| | - Thomas Meitinger
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Koenig
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Georg Leipold
- Professional Association of Pediatricians (BVKJ) of Bavaria, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
23
|
Maldonado V, Weeks B, Cho M, Turpin D, Arevalo A. Pediatric dyslipidemia. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
24
|
Sanin V, Schmieder R, Ates S, Schlieben LD, Wiehler J, Sun R, Decker M, Sander M, Holdenrieder S, Kohlmayer F, Friedmann A, Mall V, Feiler T, Dreßler A, Strom TM, Prokisch H, Meitinger T, von Scheidt M, Koenig W, Leipold G, Schunkert H. Population-based screening in children for early diagnosis and treatment of familial hypercholesterolemia: design of the VRONI study. Eur J Public Health 2022; 32:422-428. [PMID: 35165720 PMCID: PMC9159326 DOI: 10.1093/eurpub/ckac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Heterozygous familial hypercholesterolemia (FH) represents the most frequent monogenic disorder with an estimated prevalence of 1:250 in the general population. Diagnosis during childhood enables early initiation of preventive measures, reducing the risk of severe consecutive atherosclerotic manifestations. Nevertheless, population-based screening programs for FH are scarce. Methods In the VRONI study, children aged 5–14 years in Bavaria are invited to participate in an FH screening program during regular pediatric visits. The screening is based on low-density lipoprotein cholesterol measurements from capillary blood. If exceeding 130 mg/dl (3.34 mmol/l), i.e. the expected 95th percentile in this age group, subsequent molecular genetic analysis for FH is performed. Children with FH pathogenic variants enter a registry and are treated by specialized pediatricians. Furthermore, qualified training centers offer FH-focused training courses to affected families. For first-degree relatives, reverse cascade screening is recommended to identify and treat affected family members. Results Implementation of VRONI required intensive prearrangements for addressing ethical, educational, data safety, legal and organizational aspects, which will be outlined in this article. Recruitment started in early 2021, within the first months, more than 380 pediatricians screened over 5200 children. Approximately 50 000 children are expected to be enrolled in the VRONI study until 2024. Conclusions VRONI aims to test the feasibility of a population-based screening for FH in children in Bavaria, intending to set the stage for a nationwide FH screening infrastructure. Furthermore, we aim to validate genetic variants of unclear significance, detect novel causative mutations and contribute to polygenic risk indices (DRKS00022140; August 2020).
Collapse
Affiliation(s)
- Veronika Sanin
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Raphael Schmieder
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sara Ates
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Lea Dewi Schlieben
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany.,Department Computational Health, Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Jens Wiehler
- BioM Biotech Cluster Development GmbH, Martinsried, Germany
| | - Ruoyu Sun
- BioM Biotech Cluster Development GmbH, Martinsried, Germany
| | - Manuela Decker
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michaela Sander
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | - Anna Friedmann
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Germany
| | - Volker Mall
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Germany
| | - Therese Feiler
- Department of Systematic Theology and Ethics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Arne Dreßler
- Department of Systematic Theology and Ethics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tim M Strom
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - Holger Prokisch
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany.,Department Computational Health, Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Thomas Meitinger
- School of Medicine, Institute of Human Genetics, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Koenig
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Georg Leipold
- Professional Association of Pediatricians (BVKJ) of Bavaria, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | |
Collapse
|
25
|
Rhabdomyolysis due to rosuvastatin in a patient with ROHHAD syndrome. J Clin Lipidol 2021; 15:789-792. [PMID: 34600840 DOI: 10.1016/j.jacl.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
We report a 13-year-old female with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome, panhypopituitarism, dyslipidemia, type 2 diabetes mellitus, and nonalcoholic fatty liver disease, who developed rhabdomyolysis and acute kidney injury, two weeks after switching from lovastatin to rosuvastatin. She had been on lovastatin for eight years without any adverse effects.
Collapse
|
26
|
Buonuomo PS, Mastrogiorgio G, Leone G, Rana I, Gonfiantini MV, Macchiaiolo M, Vecchio D, Gnazzo M, Bartuli A. Evolocumab in the management of children <10 years of age affected by homozygous familial hypercholesterolemia. Atherosclerosis 2021; 324:148-150. [PMID: 33824001 DOI: 10.1016/j.atherosclerosis.2021.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy.
| | - Gerarda Mastrogiorgio
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| | - Giovanna Leone
- Unit of Transfusion Medicine, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| | - Ippolita Rana
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| | | | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| | - Davide Vecchio
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| | - Maria Gnazzo
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital Rome, IRCCS, Italy
| |
Collapse
|
27
|
Capra ME, Pederiva C, Banderali G, Biasucci G. Prevention starts from the crib: the pediatric point of view on detection of families at high cardiovascular risk. Ital J Pediatr 2021; 47:51. [PMID: 33673846 PMCID: PMC7934516 DOI: 10.1186/s13052-021-00985-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity in Italy. Hypercholesterolemia is a modifiable CVD risk factor. The detection and treatment of hypercholesterolemia can modify the natural history of CVD, making CVD risk for affected patients comparable to that of unaffected ones. In this scenario, the detection of families at high cardiovascular risk is the first step of CVD prevention. This multicenter, observational study is aimed at finding an effective and non-invasive screening strategy to detect families at high risk for CVD. METHODS A survey investigating the knowledge of lipid and CVD issues was distributed to the parents of all infants born at the Neonatology Unit of Piacenza City Hospital and San Paolo Hospital in Milan over a 6 months period. Overall, 554 surveys have been collected. RESULTS 26.8% newborns had parents who knew their own lipid profile, 40.2% had parents who knew the correct normal blood values of total cholesterol, 37.1% had parents who declared to have first or second degree relatives with lipid disorders, 33.7% had parents who declared to have first or second degree relatives with premature CVD CONCLUSION: Collecting a problem-tailored and accurate family history seems to be a good strategy to detect high risk families. Our data suggest that the percentage of adults who are unaware of their lipid profile, with a positive family history for CVD and/or lipid disorders is higher than expected. As a result, even the number of undetected paediatric patients at high cardiovascular risk might be greater than expected.
Collapse
Affiliation(s)
- Maria Elena Capra
- Centro Dislipidemie in Età Evolutiva, U.O. Pediatria e Neonatologia, Ospedale G. da Saliceto, Piacenza, Italy.
| | - Cristina Pederiva
- U.O. Clinica Pediatrica, Servizio Clinico Dislipidemie per Lo Studio e La Prevenzione dell'Aterosclerosi in Età Pediatrica, ASST-Santi Paolo e Carlo, Milan, Italy
| | - Giuseppe Banderali
- U.O. Clinica Pediatrica, Servizio Clinico Dislipidemie per Lo Studio e La Prevenzione dell'Aterosclerosi in Età Pediatrica, ASST-Santi Paolo e Carlo, Milan, Italy
| | - Giacomo Biasucci
- Centro Dislipidemie in Età Evolutiva, U.O. Pediatria e Neonatologia, Ospedale G. da Saliceto, Piacenza, Italy
| |
Collapse
|
28
|
Johansen AK, Bogsrud MP, Roeters van Lennep J, Narverud I, Langslet G, Retterstøl K, Holven KB. Long term follow-up of children with familial hypercholesterolemia and relatively normal LDL-cholesterol at diagnosis. J Clin Lipidol 2021; 15:375-378. [PMID: 33608220 DOI: 10.1016/j.jacl.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/22/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022]
Abstract
Familial hypercholesterolemia (FH) is a genetic disorder with high low-density lipoprotein cholesterol (LDL-C) levels and high risk of cardiovascular disease. The long-term importance of carrying an FH mutation despite having relatively normal LDL-C levels in childhood is not known. We investigated the development of LDL-C levels and need of statin therapy in children with an FH mutation, with pretreatment LDL-C ≤ 4.1 mmol/L (~160 mg/dL), followed-up at lipid clinics in Oslo, Norway and Rotterdam, The Netherlands. Of 742 FH children, 109 (15%) had pretreatment LDL-C ≤ 4.1 mmol/L (~160 mg/dL) [mean (SD) 3.5 (0.5) mmol/L; (~130 (19) mg/dL)] measured at 11.8 (3.9) years of age [mean age (SD)]. After 8.2 (5.2) years [mean (SD)] of follow-up, 71.6% had started statin treatment. Therefore, all children carrying an FH mutation, independent of cholesterol levels, should receive follow-up at specialized lipid clinics for optimal and individualized treatment.
Collapse
Affiliation(s)
- Anja K Johansen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O Box 1046 Blindern 0317 Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Rikshospitalet, P.O Box 4950, Nydalen, Oslo, Norway
| | - Martin P Bogsrud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Rikshospitalet, P.O Box 4950, Nydalen, Oslo, Norway; Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Ingunn Narverud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O Box 1046 Blindern 0317 Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Rikshospitalet, P.O Box 4950, Nydalen, Oslo, Norway
| | - Gisle Langslet
- Lipid Clinic, Oslo University Hospital, P.O Box 4950 Nydalen, 0424 Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O Box 1046 Blindern 0317 Oslo, Norway; Lipid Clinic, Oslo University Hospital, P.O Box 4950 Nydalen, 0424 Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O Box 1046 Blindern 0317 Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Rikshospitalet, P.O Box 4950, Nydalen, Oslo, Norway.
| |
Collapse
|
29
|
Camacho OFC, Molina GP, Catalá CFM, Reali JR, Cruz RM, Zenteno JC. Familial Hypercholesterolemia: Update and Review. Endocr Metab Immune Disord Drug Targets 2021; 22:198-211. [PMID: 33563162 DOI: 10.2174/1871530321666210208212148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
Knowledge of epidemiology, genetic etiopathogenesis, diagnostic criteria, and management of familial hypercholesterolemia have increased in the last two decades. Several population studies have shown that familial hypercholesterolemia is more frequent than previously thought, making this entity the most common metabolic disease with monogenic inheritence in the world. Identification of causal heterozygous pathogenic variants in LDLR, APOB, and PCSK9 genes have increased diagnostic accuracy of classical criteria (extreme hypercholesterolemia, personal / family history of premature coronary artery disease or other cardiovascular disease). Genetic screening has been recently introduced in many European countries to detect patients with familial hypercholesterolemia, mainly affected pediatric subjects, asymptomatic or those at the beggining of their disease, with the purpose of increasing surveillance and avoiding complications such as cardiovascular diseases. Cholesterol-lowering drugs should be started as soon as the diagnosis is made. Various combinations between drugs can be used when the goal is not achieved. New therapies, including small interference ribonucleic acids (siRNA) are being tested in different clinical trials.
Collapse
Affiliation(s)
| | - Glustein Pozo Molina
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Claudia Fabiola Méndez Catalá
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Julia Reyes Reali
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - René Méndez Cruz
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Juan Carlos Zenteno
- Biochemistry Department, Faculty Medicine, National Autonomous University of Mexico, Mexico City,. Mexico
| |
Collapse
|
30
|
Kavey REW, Manlhiot C, Runeckles K, Collins T, Gidding SS, Demczko M, Clauss S, Harahsheh AS, Mietus-Syder M, Khoury M, Madsen N, McCrindle BW. Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience. CJC Open 2020; 2:473-482. [PMID: 33305206 PMCID: PMC7710927 DOI: 10.1016/j.cjco.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Statin use for hypercholesterolemia in children is predominantly reported from short-term clinical trials. In this study, we assess the efficacy and safety of statin treatment in clinical pediatric practice. METHODS Records of all patients who began statin treatment at age <18 years and remained on statins for >6 months from 5 pediatric lipid clinics were reviewed. Information at baseline and from all clinic evaluations after statin initiation was recorded, including lipid measurements, statin drug/dose, safety measures (anthropometry, hepatic enzymes, creatine kinase levels), and symptoms. Lipid changes on statin therapy were assessed from baseline to 6 ± 3 months and from 6 ± 3 months to last follow-up with a mixed-effects model, using piecewise linear splines to describe temporal changes, controlling for repeated measures, sex, and age. RESULTS There were 289 patients with median low-density lipoprotein cholesterol (LDL-C) of 5.3 mmol/L (interquartile range [IQR]:4.5-6.5) and mean age of 12.4 ± 2.9 years at statin initiation. Median duration of therapy was 2.7 years (IQR: 1.6-4.5) with 95% on statins at last evaluation. There were significant decreases in total cholesterol, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 ± 3 months (P < 0.001) and from 6 ±3 months to last follow-up (P < 0.001). Triglycerides and HDL-C were unchanged but the triglyceride to HDL-C ratio decreased significantly by late follow-up. At final evaluation, median LDL-C had decreased to 3.4 mmol/L (IQR:2.8-4.2). No patient had statins discontinued for safety measures or symptoms. CONCLUSIONS In real-world clinical practice, intermediate-term statin treatment is effective and safe in children and adolescents with severe LDL-C elevation.
Collapse
Affiliation(s)
- Rae-Ellen W. Kavey
- Preventive Cardiology—Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Cedric Manlhiot
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Runeckles
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Tanveer Collins
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Samuel S. Gidding
- Preventive Cardiology—Lipid Clinic, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Matthew Demczko
- Preventive Cardiology—Lipid Clinic, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Sarah Clauss
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Ashraf S. Harahsheh
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Michele Mietus-Syder
- Preventive Cardiology Program—Lipid Clinic, Children’s National Hospital, George Washington University School of Medicine and Health, Washington, DC, USA
| | - Michael Khoury
- Pediatric Lipid Clinic, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicolas Madsen
- Pediatric Lipid Clinic, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian W. McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Mlinaric M, Bratanic N, Dragos V, Skarlovnik A, Cevc M, Battelino T, Groselj U. Case Report: Liver Transplantation in Homozygous Familial Hypercholesterolemia (HoFH)-Long-Term Follow-Up of a Patient and Literature Review. Front Pediatr 2020; 8:567895. [PMID: 33163465 PMCID: PMC7581712 DOI: 10.3389/fped.2020.567895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/28/2020] [Indexed: 01/15/2023] Open
Abstract
Homozygous familial hypercholesterolemia (HoFH) is a rare inherited metabolic disorder, frequently leading to an early cardiovascular death if not adequately treated. Since standard medications usually fail to reduce LDL-cholesterol (LDL-C) levels satisfactorily, LDL-apheresis is a mainstay of managing HoFH patients but, at the same time, very burdensome and suboptimally effective. Liver transplantation (LT) has been previously shown to be a promising alternative. We report on a 14 year-long follow-up after LT in a HoFH patient. At the age of 4, the patient was referred to our institution because of the gradually increasing number of xanthomas on the knees, elbows, buttocks, and later the homozygous mutation c.1754T>C (p.Ile585Thr) on the LDL-receptor gene was confirmed. Despite subsequent intensive treatment with the combination of diet, statins, bile acid sequestrant, probucol, and LDL-apheresis, the patient developed valvular aortic stenosis and aortic regurgitation by 12 years. At 16 years, the patient successfully underwent deceased-donor orthotopic LT. Nine years post-LT, we found total regression of the cutaneous xanthomas and atherosclerotic plaques and with normal endothelial function. Fourteen years post-LT, his clinical condition remained stable, but LDL-C levels have progressively risen. In addition, a systematic review of the literature and guidelines on the LT for HoFH patients was performed. Six of the 17 identified guidelines did not take LT as a treatment option in consideration at all. But still the majority of guidelines suggest LT as an exceptional therapeutic option or as the last resort option when all the other treatment options are inadequate or not tolerated. Most of the observed patients had some kind of cardiovascular disease before the LT. In 76% of LT, the cardiovascular burden did not progress after LT. According to our experience and in several other reported cases, the LDL-C levels are slowly increasing over time post LT. Most of the follow-up data were short termed; only a few case reports have followed patients for 10 or more years after LT. LT is a feasible therapeutic option for HoFH patients, reversing atherosclerotic changes uncontrollable by conservative therapy, thus importantly improving the HoFH patient's prognosis and quality of life.
Collapse
Affiliation(s)
- Matej Mlinaric
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nevenka Bratanic
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vlasta Dragos
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ajda Skarlovnik
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Cevc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Urh Groselj
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
32
|
Kose E, Kose M, Ozturk SI, Ozcan E, Onay H, Ozkan B. Cascade screening and treatment of children with familial hypercholesterolemia in Turkey. J Pediatr Endocrinol Metab 2020; 33:1251-1256. [PMID: 32829317 DOI: 10.1515/jpem-2020-0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Objectives Premature coronary artery disease is the most common preventable cause of death in developed countries, and familial hypercholesterolemia (FH) is the most common monogenetic disorder of lipid metabolism, predisposing for premature coronary artery. FH is the most common preventable cause of death in developed countries. In 2016, the national lipid screening program in school-age children has been started in Turkey. In this study, we aimed to evaluate the efficacy of lipid screening program, lipid-lowering treatments, and the challenges of treatments in children diagnosed with FH. Methods Patients diagnosed with FH in the pediatric metabolism outpatient clinic were retrospectively evaluated. Changes in lipid profile with dietary interventions and statin treatments were assessed. The results of cascade screening were analyzed. Results Fifty-one patients diagnosed with FH were enrolled in the study. Twenty-four (47.1%) were female. The mean age of the patients was 9.8 ± 3.2 years. Heterozygous LDLR gene mutation was detected in all patients. Three novel pathogenic variations were revealed with the genetic investigation. Forty-one (80.4%) patients had high adherence to CHILD-2 dietary recommendations. The mean low-density lipoprotein cholesterol (LDL-C) level decreased by 14.5 ± 7.6% after dietary intervention. Parents refused to start statin treatment in 8 (15.7%) patients. Statin treatment was initiated to 22 (43.1%) patients. Mean LDL-C level decreased from 204.1 ± 19.1 mg/dL to 137.0 ± 13.1 mg/dL. In cascade screening, 7 (13.7%) parents without a diagnosis of FH were diagnosed with FH. After the screening program, statin treatment was initiated for 18 (35.3%) parents and 7 (16.3%) siblings. Conclusions We can conclude that screening for FH in children is crucial for diagnosing FH not only in children but also in their relatives. Although statins are safe and effective in achieving the target LDL-C level, we determined significant resistance for initiating statin treatment in patients.
Collapse
Affiliation(s)
- Engin Kose
- Department of Pediatric Metabolism and Nutrition, Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Melis Kose
- Department of Pediatric Metabolism and Nutrition, Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Sureyya Ipek Ozturk
- Department of Nutrition and Dietetics, Dr. Behçet Uz Children Research and Training Hospital, Izmir, Turkey
| | - Esra Ozcan
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children Research and Training Hospital, Izmir, Turkey
| | - Behzat Ozkan
- Department of Pediatric Metabolism and Nutrition, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
33
|
Rodríguez-Borjabad C, Malo AI, Ibarretxe D, Girona J, Heras M, Ferré R, Feliu A, Salvadó M, Varela A, Amigó N, Masana L, Plana N. Efficacy of therapeutic lifestyle changes on lipid profiles assessed by NMR in children with familial and non-familial hypercholesterolemia. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:49-58. [PMID: 32005605 DOI: 10.1016/j.arteri.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The first line of therapy in children with hypercholesterolaemia is therapeutic lifestyle changes (TLSC). The efficacy of lifestyle intervention in children with familial hypercholesterolaemia (FH), where LDL-C levels are genetically driven, deserves a focused study. AIMS To evaluate the impact of a lifestyle education program, focused on food patterns and physical activity, on lipid profiles assessed by nuclear magnetic resonance (NMR) in children with FH vs. non-FH. METHODS Phase 1 was a cross-sectional study of baseline characteristics, and phase 2 was a prospective TLSC intervention study. In total, the study included 238 children (4 to 18 years old; 47% girls) attending the lipid unit of our hospital due to high cholesterol levels. Eighty-five were diagnosed with FH (72% genetic positive), and 153 were diagnosed with non-Familial hypercholesterolaemia. A quantitative food frequency questionnaire (FFQ) including 137 items was used. Physical activity (PA) was assessed by the Minnesota questionnaire. The lipid profile was assessed using the 2D-1H-NMR (Liposcale test). A total of 127 children (81 in the FH group) participated in the prospective phase and were re-assessed after 1 year of the TLSC intervention, consisting of education on lifestyle changes delivered by a specialized nutritionist. RESULTS The FH and non-FH groups were similar in anthropometry and clinical data, except that those in the FH were slightly younger than those in the non-FH group. Both the FH and non-FH groups showed a similar diet composition characterized by a high absolute calorie intake and a high percentage of fat, mainly saturated fat. The PA was below the recommended level in both groups. After one year of TLSC, the percentage of total and saturated fats was reduced, and the amount of fiber increased significantly in both groups. The percentage of protein increased slightly. The number of children engaged in at least 1 hour/day of PA increased by 56% in the FH group and by 53% in the non-FH group, and both these increases were significant. The total and small-LDL particle numbers were reduced in both groups, although the absolute change was greater in the FH group than in the non-FH group. CONCLUSIONS Educational strategies to implement TLSC in children lead to empowerment, increased adherence, and overall metabolic improvement in children with high blood cholesterol, including those with FH.
Collapse
Affiliation(s)
- Cèlia Rodríguez-Borjabad
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Ana Irene Malo
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Josefa Girona
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Mercedes Heras
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Raimon Ferré
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Albert Feliu
- Pediatrics Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | | | | | - Núria Amigó
- Department of Electronic Engineering and Automation, Universitat Rovira i Virgili, IISPV, Tarragona, Spain; Biosfer Teslab, Reus, Tarragona, Spain
| | - Luis Masana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
| | - Núria Plana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | | |
Collapse
|
34
|
Ashraf AP, Kohn B, Wilson DP. Improving Long-Term Outcomes of Youth With Lipid Abnormalities-Expanding the Role of Pediatric Endocrinologists. J Clin Endocrinol Metab 2019; 104:4421-4426. [PMID: 31120509 DOI: 10.1210/jc.2019-00150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/17/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT There is a disturbingly high prevalence of dyslipidemia in youth. Although pediatric endocrinologists are aware of the substantial cardiovascular (CV) risk associated with monogenic disorders of lipid and lipoprotein metabolism, relatively few recognize the CV disease (CVD)-related morbidity and premature mortality incurred by common endocrine disorders associated with dyslipidemia, such as diabetes mellitus, growth hormone deficiency, congenital adrenal hyperplasia, and hypopituitarism. OBJECTIVE In this article, we discuss the expanding role of pediatric endocrinologists in CV health and risk prevention. DESIGN We reviewed available literature and summarized discussions with opinion leaders in pediatric endocrinology to accomplish the following: (i) provide an overview of this timely topic; (ii) identify opportunities for targeted education; and (iii) discuss ways of expanding clinical services to improve outcomes. RESULTS In addition to well-known genetic disorders of lipid and lipoprotein metabolism, youth with common endocrine disorders, including type 1 and type 2 diabetes, would benefit from cholesterol screening and in some, early intervention, including use of lipid-lowering medications. Despite the growing need, the location and extent of services available to youth with dyslipidemia and the availability of providers with experience in treatment of dyslipidemia are largely unknown but likely inadequate to provide accessible, timely, and cost-effective intervention. CONCLUSION With a new awareness of opportunities to prevent premature CVD in youth, including those with common endocrine disorders and CVD-related events during adulthood, there is an urgent need for additional clinical services and targeted education of current as well as future pediatric endocrinologists.
Collapse
Affiliation(s)
- Ambika P Ashraf
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenda Kohn
- Division Pediatric Endocrinology and Diabetes, Hassenfeld Children's Hospital at New York University-Langone Medical Center, New York University School of Medicine, New York, New York
| | - Don P Wilson
- Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, Texas
| |
Collapse
|
35
|
Mamann N, Lemale J, Karsenty A, Dubern B, Girardet JP, Tounian P. Intermediate-Term Efficacy and Tolerance of Statins in Children. J Pediatr 2019; 210:161-165. [PMID: 31053349 DOI: 10.1016/j.jpeds.2019.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the intermediate-term efficacy and tolerance of statins in children and adolescents with familial hypercholesterolemia. STUDY DESIGN A total of 131 children or adolescents treated with statins for familial hypercholesterolemia were prospectively included. The efficacy of treatment was established by the percentage of children who achieved low density lipoprotein-cholesterol (LDL-C) levels <160 mg/dL during treatment. Treatment tolerance was evaluated by the occurrence of clinical or laboratory side effects, regularity of increases in height and weight, and pubertal development. RESULTS The median duration of treatment with statins was 4 years. A median decrease of 32% in LDL-C levels was observed (P < .0001). The therapeutic target (LDL-C <160 mg/dL) was achieved in 67% of cases. Increases in height and weight and sexual maturation were not affected by the treatment. Minor side effects were reported for 24 (18.4%) patients including 3 cases of a clinically asymptomatic increase in creatine phosphokinase (CPK) levels, 2 cases of an increase in CPK levels with muscular symptoms, 14 cases of myalgia without an increase in CPK levels, 3 cases of abdominal pain, 1 case of dysuria, and 1 case of diffuse pain. None of these side effects led to the discontinuation of statin therapy, although a change of statin was required in 7 cases. This new statin was tolerated in all cases. No patients had abnormal liver function during treatment. CONCLUSIONS The results of this large cohort confirm the intermediate-term safety and efficacy of statin therapy in children with familial hypercholesterolemia.
Collapse
Affiliation(s)
- Nathalie Mamann
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
| | - Julie Lemale
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Alexandra Karsenty
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Béatrice Dubern
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jean-Philippe Girardet
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| |
Collapse
|
36
|
Kreissl A, Walleczek N, Espina PR, Hallwirth U, Greber-Platzer S. Selective screening for familial hypercholesterolemia in Austrian children - first year results. BMC Pediatr 2019; 19:208. [PMID: 31238984 PMCID: PMC6591992 DOI: 10.1186/s12887-019-1586-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/17/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH), the most frequent monogenetic hereditary disorder, is underdiagnosed and undertreated. Early identification of FH is essential because of the increased risk for premature cardiovascular diseases and childhood might be the optimal period for cholesterol screening. Aim of this selective screening was to detect familial hypercholesterolemia, the most frequent monogenetic hereditary disorder in children to guarantee early detection and treatment. The Austrian strategy for primary schools, to perform a pre-school examination by school physicians, allows to reach all children aged 5-7 years. METHODS The screening was conducted within the school enrolment examinations in all 215 public primary schools in Vienna between January to May 2017. Positive cholesterol screening was defined by non-HDL-C > 160 mg/dL and/or LDL-C > 130 mg/dL. RESULTS In total, 18,152 children had their school enrolment examination. From 133 tested pre-school children, nine individuals were positive-screened with a mean LDL-C of 161 ± 26 mg/dL, non-HDL-C of 181 ± 24 mg/dL and total cholesterol (TC) of 239 ± 23 mg/dL. From 85 siblings, four individuals were positively screened with a mean LDL-C of 150 ± 7 mg/dL, non-HDL-C of 184 ± 8 mg/dL and TC of 231 ± 10 mg/dL. Patients did not have any xanthomas, xanthelasms, arcus lipoides, or any cardiovascular comorbidities. CONCLUSIONS Screening at early childhood by school physicians seems to be a successful strategy and possible. With this Austrian selective screening method, FH Kids Austria, we could find nine patients with positive raised level LDL-cholesterol and/or non-HDL cholesterol out of 133 blood tests. Prevention of cardiovascular diseases is essential and it is our duty to increase the awareness of this disease. Limitations of the FH Kids project were reduced participation of school physicians and refusal of the parents.
Collapse
Affiliation(s)
- Alexandra Kreissl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nina Walleczek
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pinky Rose Espina
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ulrike Hallwirth
- Municipal Authority of the City Vienna, Municipal Department 15, Health Service of the City of Vienna, Vienna, Austria
| | - Susanne Greber-Platzer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
37
|
Radaelli G, Sausen G, Cesa CC, Santos FDS, Portal VL, Neyeloff JL, Pellanda LC. Statin Treatments And Dosages In Children With Familial Hypercholesterolemia: Meta-Analysis. Arq Bras Cardiol 2018; 111:810-821. [PMID: 30365601 PMCID: PMC6263457 DOI: 10.5935/abc.20180180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Abstract
Background Children with familial hypercholesterolemia may develop early endothelial
damage leading to a high risk for the development of cardiovascular disease
(CVD). Statins have been shown to be effective in lowering LDL cholesterol
levels and cardiovascular events in adults. The effect of statin treatment
in the pediatric population is not clearly demonstrated. Objective To systematically review the literature to evaluate the effects of different
statins and dosages in total cholesterol levels in children and adolescents
with familial hypercholesterolemia. We also aimed to evaluate statin safety
in this group. Methods PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO and LILACS
databases, were searched for articles published from inception until
February 2016. Two independent reviewers performed the quality assessment of
the included studies. We performed a meta-analysis with random effects and
inverse variance, and subgroup analyses were performed. Results Ten trials involving a total of 1543 patients met the inclusion criteria. Our
study showed reductions in cholesterol levels according to the intensity of
statin doses (high, intermediate and low): (-104.61 mg/dl, -67.60 mg/dl,
-56.96 mg/dl) and in the low-density lipoprotein cholesterol level:
[-105.03 mg/dl (95% CI -115.76, -94.30), I2 19.2%],
[-67.85 mg/dl (95% CI -83.36, -52.35), I2 99.8%],
[-58.97 mg/dl (95% CI -67.83, -50.11), I2 93.8%. The duration of
statin therapy in the studies ranged from 8 to 104 weeks, precluding
conclusions about long-term effects. Conclusion Statin treatment is efficient in lowering lipids in children with FH. There
is need of large, long-term and randomized controlled trials to establish
the long-term safety of statins.
Collapse
Affiliation(s)
- Graciane Radaelli
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Grasiele Sausen
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Claudia Ciceri Cesa
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | | | - Vera Lucia Portal
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Jeruza Lavanholi Neyeloff
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Lucia Campos Pellanda
- Instituto de Cardiologia - Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| |
Collapse
|
38
|
Brett T, Qureshi N, Gidding S, Watts GF. Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part. Atherosclerosis 2018; 277:399-406. [DOI: 10.1016/j.atherosclerosis.2018.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
|
39
|
Gaudet D, Langslet G, Gidding SS, Luirink IK, Ruzza A, Kurtz C, Lu C, Somaratne R, Raal FJ, Wiegman A. Efficacy, safety, and tolerability of evolocumab in pediatric patients with heterozygous familial hypercholesterolemia: Rationale and design of the HAUSER-RCT study. J Clin Lipidol 2018; 12:1199-1207. [DOI: 10.1016/j.jacl.2018.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
|
40
|
|
41
|
Pang J, Martin AC, Bates TR, Hooper AJ, Bell DA, Burnett JR, Norman R, Watts GF. Parent-child genetic testing for familial hypercholesterolaemia in an Australian context. J Paediatr Child Health 2018; 54:741-747. [PMID: 29626384 DOI: 10.1111/jpc.13898] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/18/2017] [Accepted: 01/14/2018] [Indexed: 01/18/2023]
Abstract
AIM The aim of this study was to evaluate the clinical outcome of parent-child testing for familial hypercholesterolaemia (FH) employing genetic testing and the likely additional cost of treating each child. METHODS Parent-child testing for gene variants causative of FH was carried out according to Australian guidelines. The number of new cases detected, the low-density lipoprotein (LDL)-cholesterol that best predicted a mutation and the proportional reduction in LDL-cholesterol following statin treatment was evaluated. Treatment costs were calculated as the cost per mmol/L reduction in LDL-cholesterol. RESULTS A total of 126 adult patients, known to have a pathogenic mutation causative of FH, and their children were studied. From 244 children identified, 148 (60.7%) were genetically screened; 84 children were identified as mutative positive (M+) and 64 as mutative negative. Six of the M+ children were already on statin treatment; 40 were subsequently treated with low-dose statins, with LDL-cholesterol falling significantly by 38% (P < 0.001). The estimated cost per mmol/L reduction of LDL-cholesterol of a child receiving statins from ages 10 to 18 years is AU$1361, which can potentially be cost-effective. An LDL-cholesterol threshold of 3.5 mmol/L had a sensitivity of 92.8% and specificity of 96.6% for the detection of a mutation. CONCLUSION Genetic testing of children of affected parents with FH is an effective means of detecting new cases of FH. Cascade testing can enable early statin therapy with significant reductions in LDL-cholesterol concentration.
Collapse
Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Timothy R Bates
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,St John of God Midland Public and Private Hospitals, Perth, Western Australia, Australia
| | - Amanda J Hooper
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Western Australia, Australia
| | - Damon A Bell
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John R Burnett
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
42
|
King K, Macken A, Blake O, O'Gorman CS. Cholesterol screening and statin use in children: a literature review. Ir J Med Sci 2018; 188:179-188. [PMID: 29858795 DOI: 10.1007/s11845-018-1835-9] [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: 12/12/2016] [Accepted: 05/18/2018] [Indexed: 01/24/2023]
Abstract
Atherosclerosis begins in childhood. Fatty streaks, the earliest precursor of atherosclerotic lesions, have been found in the coronary arteries of children of 2 years of age. Hypercholesterolaemia is a risk factor for coronary artery disease. Hypercholesterolaemia can be either primary, when it is characteristic of the main disease, or secondary when it occurs as a result of either a disease process or drug treatment. Given the risk of vascular disease, including myocardial infarction (MI), cerebrovascular accidents (CVA, also known as strokes), peripheral vascular disease (PVD) and ruptured aortic aneurysm, which may follow atherosclerosis, it is important to prevent or slow the early development of atherosclerotic lesions. This prevention necessitates the control of key risk factors such hypercholesterolaemia, dyslipidaemia, hypertension etc. However, at what point this prevention ought to occur, and in what form, is uncertain. Using pharmacological primary prevention for hypercholesterolaemia in the paediatric population is controversial. In an adult patient, hypercholesterolaemia warrants the initiation of a statin. Statins, also known as hydroxymethylglutaryl co-enzyme A inhibitors (or HMG-CoA inhibitors) act by altering cholesterol metabolism. In the paediatric population, the clinical course of vascular disease and the effect of altering this clinical course are less certain. This article reviews the published literature on hypercholesterolaemia in children and the use of statins as a treatment for dyslipidaemia in children. The US National Cholesterol Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents 2012 guidelines (NCEP guidelines) regarding the recognition and treatment of childhood dyslipidaemia are reviewed.
Collapse
Affiliation(s)
- Karen King
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland.
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Alan Macken
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | - Ophelia Blake
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Department of Biochemistry, University Hospital, Limerick, Ireland
| | - Clodagh S O'Gorman
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
| |
Collapse
|
43
|
Kaestner TL, Bento VF, Pazin DC, Baena CP, Olandoski M, Abreu GA, Kuschnir MCC, Bloch KV, Faria-Neto JR. Prevalence of high cholesterol levels suggestive of familial hypercholesterolemia in Brazilian adolescents: Data from the study of cardiovascular risk in adolescents. J Clin Lipidol 2018; 12:403-408. [DOI: 10.1016/j.jacl.2017.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
|
44
|
Lee CJ, Lee JH, Choi S, Kim SH, Kang HJ, Lee SH, Park KS. Screening, Diagnosis, and Treatment of Familial Hypercholesterolemia: Symposium of the Education Committee, Korean Society of Lipid and Atherosclerosis. J Lipid Atheroscler 2018. [DOI: 10.12997/jla.2018.7.2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chan Joo Lee
- Department of Health Promotion, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Shin-Hye Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| |
Collapse
|
45
|
Defesche JC, Gidding SS, Harada-Shiba M, Hegele RA, Santos RD, Wierzbicki AS. Familial hypercholesterolaemia. Nat Rev Dis Primers 2017; 3:17093. [PMID: 29219151 DOI: 10.1038/nrdp.2017.93] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Familial hypercholesterolaemia is a common inherited disorder characterized by abnormally elevated serum levels of low-density lipoprotein (LDL) cholesterol from birth, which in time can lead to cardiovascular disease (CVD). Most cases are caused by autosomal dominant mutations in LDLR, which encodes the LDL receptor, although mutations in other genes coding for proteins involved in cholesterol metabolism or LDLR function and processing, such as APOB and PCSK9, can also be causative, although less frequently. Several sets of diagnostic criteria for familial hypercholesterolaemia are available; common diagnostic features are an elevated LDL cholesterol level and a family history of hypercholesterolaemia or (premature) CVD. DNA-based methods to identify the underlying genetic defect are desirable but not essential for diagnosis. Cascade screening can contribute to early diagnosis of the disease in family members of an affected individual, which is crucial because familial hypercholesterolaemia can be asymptomatic for decades. Clinical severity depends on the nature of the gene that harbours the causative mutation, among other factors, and is further modulated by the type of mutation. Lifelong LDL cholesterol-lowering treatment substantially improves CVD-free survival and longevity. Statins are the first-line therapy, but additional drugs, such as ezetimibe, bile acid sequestrants, PCSK9 inhibitors and other emerging therapies, are often required.
Collapse
Affiliation(s)
- Joep C Defesche
- Department of Clinical Genetics, Academic Medical Centre, PO Box 22 660, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Robarts Research Institute, 4288A 1151 Richmond Street North, University of Western Ontario, N6A 5B7 London, Ontario, Canada
| | - Raul D Santos
- Lipid Clinic Heart Institute (Incor), University of São Paulo, Medical School Hospital, São Paulo, Brazil.,Preventive Medicine Centre and Cardiology Program Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Anthony S Wierzbicki
- Metabolic Medicine and Chemical Pathology, Guy's and St. Thomas' Hospitals, London, UK
| |
Collapse
|
46
|
Harada-Shiba M, Kastelein JJP, Hovingh GK, Ray KK, Ohtake A, Arisaka O, Ohta T, Okada T, Suganami H, Wiegman A. Efficacy and Safety of Pitavastatin in Children and Adolescents with Familial Hypercholesterolemia in Japan and Europe. J Atheroscler Thromb 2017; 25:422-429. [PMID: 29187694 PMCID: PMC5945555 DOI: 10.5551/jat.42242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: Children with Familial Hypercholesterolemia (FH) are widely prescribed statins, and it has been suggested that the effects of statins differ among ethnicities. We compared the efficacy and safety of pitavastatin in children and adolescents with FH in clinical trials conducted in Japan and Europe. Methods: Low-density lipoprotein cholesterol (LDL-C) reductions, adjusted for confounding factors, and safety were compared between the studies in Japan and Europe. In the Japanese study, 14 males with heterozygous FH, aged 11.8 ± 1.6 years, were randomized to 52-week double-blind treatment with 1 or 2 mg/day pitavastatin. In the European study, 106 children and adolescents with high risk hyperlipidemia (103 heterozygous FH), aged 10.6 ± 2.9 years, were randomized to 12-week double-blind treatment with 1, 2 or 4 mg/day pitavastatin or placebo; 84 of these patients and 29 new patients participated in a 52-week open-label extension study. Results: Age, body weight and baseline LDL-C were identified as factors influencing LDL-C reduction. There were no significant differences in the adjusted mean percentage reduction in LDL-C in Japanese and European children by pitavastatin (24.5% and 23.6%, respectively at 1 mg/day and 33.5% and 30.8%, respectively at 2 mg/day). Pitavastatin was well tolerated without any difference in the frequency or nature of adverse events between the treatment groups, or between the studies. Conclusion: There were no significant differences between the efficacy or safety of pitavastatin in Japanese and European children and adolescents with FH, suggesting no relevant ethnic differences in the safety or efficacy of pitavastatin.
Collapse
Affiliation(s)
- Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam
| | - Kausik K Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London
| | - Akira Ohtake
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University
| | - Osamu Arisaka
- Department of Pediatrics, Dokkyo Medical University School of Medicine
| | - Takao Ohta
- Department of Child Health and Welfare (Pediatrics), Faculty of Medicine, University of the Ryukyu
| | - Tomoo Okada
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | | | - Albert Wiegman
- Department of Pediatrics, Academic Medical Center, University of Amsterdam
| |
Collapse
|
47
|
Sriram S, St Sauver JL, Jacobson DJ, Fan C, Lynch BA, Cristiani V, Kullo IJ, Lteif AN, Kumar S. Temporal trends in lipid testing among children and adolescents: A population based study. Prev Med Rep 2017; 8:267-272. [PMID: 29204335 PMCID: PMC5705799 DOI: 10.1016/j.pmedr.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Unfavorable lipid levels during childhood are associated with subsequent development of atherosclerotic cardiovascular disease. The American Academy of Pediatrics and National Heart, Lung and Blood Institute in 2011 recommended universal lipid screening for children between ages 9–11 years and between ages 17–21 years. The objective of the study was to determine temporal trends in lipid testing among children and young adults in a mid-western population. The Rochester Epidemiology Project database was used to identify lipid testing in ages 2–21 years (n = 51,176) in the Olmsted County population from January 1, 2008 through December 31, 2014. Generalized estimating equations with Poisson distribution were used to test for temporal trends in lipid testing across the age groups. There was modest increase in lipid testing in children in the age groups, 9–11 years and 17–21 years (1.5% in 2008 to 2.2% in 2014, P < 0.001 and 4.4% in 2008 to 4.6% in 2014, P = 0.02, respectively). There was a significant decrease in proportion of 17–21 year olds with elevated total cholesterol (16.2% in 2008 to 11.6% in 2014; P = 0.01) and non-high density lipoprotein cholesterol (22.6% in 2008 to 12.6% in 2014; P < 0.001). In this population-based study, rates of lipid testing increased minimally only in the last six years. Further longitudinal studies are warranted to improve guideline dissemination and address attitudes, practices and barriers to lipid testing in children and young adults. In 2011, universal lipid screening was recommended for children and young adults. We investigated temporal trends in lipid testing in a mid-western community. There was only a minimal increase in rates of lipid testing. There is need for improve guideline dissemination and implementation.
Collapse
Key Words
- ASCVD, atherosclerotic cardiovascular disease
- Children
- Dyslipidemia
- HDL, high density lipoprotein
- HDL-C, high density lipoprotein cholesterol
- Hypercholesterolemia
- LDL-C, low density lipoprotein cholesterol
- Lipids
- NCEP, National Cholesterol Education Program
- NHANES, National Health and Nutrition Examination Survey
- NHLBI, National Heart, Lung, and Blood Institute
- REP, Rochester Epidemiology Project
- Screening
- TC, total cholesterol
- mg/dL, milligrams/deciliters
- non-HDL-C, non high density lipoprotein cholesterol
Collapse
Affiliation(s)
- Swetha Sriram
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.,Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Debra J Jacobson
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chun Fan
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Brian A Lynch
- Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Valeria Cristiani
- Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
48
|
Circulating miR-200c is up-regulated in paediatric patients with familial hypercholesterolaemia and correlates with miR-33a/b levels: implication of a ZEB1-dependent mechanism. Clin Sci (Lond) 2017. [DOI: 10.1042/cs20171121 28811385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypercholesterolaemia provokes reactive oxygen species (ROS) increase and is a major risk factor for cardiovascular disease (CVD) development. We previously showed that circulating miR-33a/b expression levels were up-regulated in children with familial hypercholesterolaemia (FH). miR-33a/b control cholesterol homoeostasis and recently miR-33b has been demonstrated to directly target the transcription factor zinc finger E-box-binding homeobox 1 (ZEB1). The latter acts in a negative feedback loop with the miR-200 family. Our previous studies showed that the ROS-dependent miR-200c up-regulation induces endothelial dysfunction and provokes a ZEB1-dependent apoptosis and senescence. In the present study, we aimed to verify whether circulating miR-200c was induced in FH children, and whether a correlation existed with miR-33a/b. Total RNA was extracted from plasma of 28 FH children and 25 age-matched healthy subjects (HS) and miR-200c levels were measured. We found that miR-200c was up-regulated in FH compared with HS (4.00 ± 0.48-fold increase, P<0.05) and exhibited a positive correlation with miR-33a/b. miR-200c did not correlate with plasma lipids, but correlated with C-reactive protein (CRP) plasma levels and glycaemia (GLI). Ordinary least squares (OLS) regression analysis revealed that miR-200c was significantly affected by GLI and by miR-33a (P<0.01; P<0.001 respectively). Moreover, we found that miR-33 overexpression, in different cell lines, decreased ZEB1 expression and up-regulated both the intracellular and the extracellular miR-200c expression levels. In conclusion, circulating miR-200c is up-regulated in FH, probably due to oxidative stress and inflammation and via a miR-33a/b-ZEB1-dependent mechanism. The present study could provide the first evidence to point to the use of miR-33a/b and miR-200c, as early biomarkers of CVD, in paediatric FH.
Collapse
|
49
|
Circulating miR-200c is up-regulated in paediatric patients with familial hypercholesterolaemia and correlates with miR-33a/b levels: implication of a ZEB1-dependent mechanism. Clin Sci (Lond) 2017; 131:2397-2408. [DOI: 10.1042/cs20171121] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/04/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022]
Abstract
Hypercholesterolaemia provokes reactive oxygen species (ROS) increase and is a major risk factor for cardiovascular disease (CVD) development. We previously showed that circulating miR-33a/b expression levels were up-regulated in children with familial hypercholesterolaemia (FH). miR-33a/b control cholesterol homoeostasis and recently miR-33b has been demonstrated to directly target the transcription factor zinc finger E-box-binding homeobox 1 (ZEB1). The latter acts in a negative feedback loop with the miR-200 family. Our previous studies showed that the ROS-dependent miR-200c up-regulation induces endothelial dysfunction and provokes a ZEB1-dependent apoptosis and senescence. In the present study, we aimed to verify whether circulating miR-200c was induced in FH children, and whether a correlation existed with miR-33a/b. Total RNA was extracted from plasma of 28 FH children and 25 age-matched healthy subjects (HS) and miR-200c levels were measured. We found that miR-200c was up-regulated in FH compared with HS (4.00 ± 0.48-fold increase, P<0.05) and exhibited a positive correlation with miR-33a/b. miR-200c did not correlate with plasma lipids, but correlated with C-reactive protein (CRP) plasma levels and glycaemia (GLI). Ordinary least squares (OLS) regression analysis revealed that miR-200c was significantly affected by GLI and by miR-33a (P<0.01; P<0.001 respectively). Moreover, we found that miR-33 overexpression, in different cell lines, decreased ZEB1 expression and up-regulated both the intracellular and the extracellular miR-200c expression levels. In conclusion, circulating miR-200c is up-regulated in FH, probably due to oxidative stress and inflammation and via a miR-33a/b-ZEB1-dependent mechanism. The present study could provide the first evidence to point to the use of miR-33a/b and miR-200c, as early biomarkers of CVD, in paediatric FH.
Collapse
|
50
|
Martin AC, Bell DA, Brett T, Watts GF. Beyond cascade screening: detection of familial hypercholesterolaemia at childhood immunization and other strategies. Curr Opin Lipidol 2017; 28:321-327. [PMID: 28426524 DOI: 10.1097/mol.0000000000000423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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 hypercholesterolaemia is a common genetic disorder that accelerates premature coronary heart disease. Although effective treatments are available, the majority of individuals remain undiagnosed. We review new evidence for improving the detection of familial hypercholesterolaemia. RECENT FINDINGS Recent studies have demonstrated that universal screening of children for familial hypercholesterolaemia may be highly effective at the time of immunization if combined with reverse cascade testing of adult family members, who have a more immediate risk of a coronary event. Alerts on laboratory reports and the application of bioinformatics to electronic health records may also be useful for identifying familial hypercholesterolaemia in community settings. Effective detection, diagnosis, and codification of familial hypercholesterolaemia are essential for the development of registries. SUMMARY Although the cost-effectiveness of screening programs for familial hypercholesterolaemia in childhood remains to be established, combining universal and reverse cascade screening, complemented by opportunistic identification of individuals in high-risk settings, use of laboratory alerts, and screening of electronic health records are likely to have a high yield in the detection of familial hypercholesterolaemia in the community.
Collapse
Affiliation(s)
- Andrew C Martin
- aDepartment of General Paediatrics, Princess Margaret Hospital for Children bSchool of Paediatrics and Child Health cFaculty of Health and Medical Sciences, School of Medicine, University of Western Australia dLipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth eGeneral Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | | | | |
Collapse
|