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Gijón-Conde T, Ferré Sánchez C, Ibáñez Delgado I, Rodríguez Jiménez B, Banegas JR. Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:1-11. [PMID: 37743130 DOI: 10.1016/j.arteri.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5μIU/mL. RESULTS 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.
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Affiliation(s)
- Teresa Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España; Unidad Docente de Medicina de Familia, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España; Asociación MAdrileña de Riesgo Enfermedad VAscular (AMAREVA), Madrid, España.
| | - Carolina Ferré Sánchez
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | - Isabel Ibáñez Delgado
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | | | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Coutinho ER, Miname MH, Rocha VZ, Bittencourt MS, Jannes CE, Krieger JE, Pereira AC, Santos RD. Cardiovascular disease onset in old people with severe hypercholesterolemia. Atherosclerosis 2023; 365:9-14. [PMID: 36646017 DOI: 10.1016/j.atherosclerosis.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) variants are associated with higher atherosclerotic cardiovascular disease risk (ASCVD) even when compared with other forms of severe hypercholesterolemia, especially in young people. Lipid lowering therapies (LLT) may change hypercholesterolemia natural history. This study aimed at evaluating factors associated with occurrence of ASCVD in old severe hypercholesterolemics diagnosed or not with FH and undergoing LLT. METHODS Hypercholesterolemic individuals ≥60 years participating on a genetic cascade screening for FH were divided in 4 groups (2 × 2) according to the presence (variant+) or not (variant-) of FH genetic variants and previous ASCVD (ASCVD+ and ASCVD-). Biomarkers associated with new incident ASCVD events were tested using Cox models. Continuous data shown as medians (%25; %75). RESULTS From 4,111 genotyped individuals, 377 (9.1%) were elderly [age 66 (63; 71) years], 28.9% males, 42.7% variant+, 32.1% with previous ASCVD, LLT duration 9 (5; 16) years, and on treatment LDL-cholesterol 144 (109; 200) mg/dL. After 4.8 (7; 3) years of follow up there were 47 incident events (12.4%, 2.7% patient/year). The annualized event rates were 0.8% (95% CI 0.36%; 1.70%), 2.3% (95% CI 1.3%; 4.1%), 5.2% (95% CI 2.8%; 9.7%) and 6.3% (95% CI 4.0%; 10.0%) respectively for groups variant-/ASCVD-, variant+/ASCVD-, variant-/ASCVD+ and, variant+/ASCVD+ (p log rank p < 0.001). Only presence of previous ASCVD was independently associated with incident ASCVD [hazard ratio 3.236 (95%CI 1.497-6.993, p = 0.003)]. No interaction was found for previous ASCVD and variants. CONCLUSIONS In old severe hypercholesterolemic individuals undergoing long-term LLT previous ASCVD was associated with incident events while FH causing variants were not.
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Affiliation(s)
- Elaine R Coutinho
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil
| | - Marcio H Miname
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil
| | - Viviane Z Rocha
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil
| | | | - Cinthia E Jannes
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil
| | - Jose E Krieger
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil
| | - Alexandre C Pereira
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil; Genetics Department Harvard Medical School, Boston, MA, USA
| | - Raul D Santos
- Heart Institute (InCor), University of São Paulo, Medical School Hospital (FMUSP), Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
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Zubielienė K, Valterytė G, Jonaitienė N, Žaliaduonytė D, Zabiela V. Familial Hypercholesterolemia and Its Current Diagnostics and Treatment Possibilities: A Literature Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1665. [PMID: 36422206 PMCID: PMC9692978 DOI: 10.3390/medicina58111665] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 09/30/2023]
Abstract
Familial hypercholesterolemia (FH) is a common, inherited disorder of cholesterol metabolism. This pathology is usually an autosomal dominant disorder and is caused by inherited mutations in the APOB, LDLR, and PCSK9 genes. Patients can have a homozygous or a heterozygous genotype, which determines the severity of the disease and the onset age of cardiovascular disease (CVD) manifestations. The incidence of heterozygous FH is 1: 200-250, whereas that of homozygous FH is 1: 100.000-160.000. Unfortunately, FH is often diagnosed too late and after the occurrence of a major coronary event. FH may be suspected in patients with elevated blood low-density lipoprotein cholesterol (LDL-C) levels. Moreover, there are other criteria that help to diagnose FH. For instance, the Dutch Lipid Clinical Criteria are a helpful diagnostic tool that is used to diagnose FH. FH often leads to the development of early cardiovascular disease and increases the risk of sudden cardiac death. Therefore, early diagnosis and treatment of this disease is very important. Statins, ezetimibe, bile acid sequestrants, niacin, PCSK9 inhibitors (evolocumab and alirocumab), small-interfering-RNA-based therapeutics (inclisiran), lomitapide, mipomersen, and LDL apheresis are several of the available treatment possibilities that lower LDL-C levels. It is important to say that the timeous lowering of LDL-C levels can reduce the risk of cardiovascular events and mortality in patients with FH. Therefore, it is essential to increase awareness of FH in order to reduce the burden of acute coronary syndrome (ACS).
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Affiliation(s)
- Kristina Zubielienė
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Hospital, LT-45130 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, LT-44307, Kaunas, Lithuania
| | - Gintarė Valterytė
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| | - Neda Jonaitienė
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| | - Diana Žaliaduonytė
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Hospital, LT-45130 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, LT-44307, Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, LT-44307, Kaunas, Lithuania
- Institute of Cardiology Kaunas, Cardiology Research Automation Laboratory, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
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Sánchez A, Bustos P, Honorato P, Burgos CF, Barriga N, Jannes CE, Sáez K, Alonso R, Asenjo S, Radojkovic C. Phenotypic characterization and predictive analysis of p.Asp47Asn LDL receptor mutation associated with Familial Hypercholesterolemia in a Chilean population. J Clin Lipidol 2021; 15:366-374.e1. [PMID: 33547002 DOI: 10.1016/j.jacl.2021.01.002] [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] [Received: 07/07/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an inherited disorder mainly caused by mutations in the LDL receptor (LDL-R) and characterized by elevation of low-density lipoprotein cholesterol (LDL-C) levels and premature cardiovascular disease. OBJECTIVE In this study, we evaluated the clinical phenotype of the p.Asp47Asn, described as an uncertain pathogenic variant, and its effect on the structure of LDL-R and ligand interactions with apolipoproteins. METHODS 27 children and adolescents with suspected FH diagnosis were recruited from a pediatric endocrinology outpatient clinic. Blood samples were collected after 12 h fasting for lipid profile analysis. DNA sequencing was performed for six FH-related genes by Ion Torrent PGM platform and copy number variation by MLPA. For index cases, a familial cascade screening was done restricted to the same mutation found in the index case. In silico analysis were developed to evaluate the binding capacity of LDL-R to apolipoproteins B100 and E. RESULTS Lipid profile in children and adolescents demonstrated higher LDL-C levels in p.Asp47Asn carriers compared to the wild type genotype. In silico analysis predicted a reduction in the binding capacity of the ligand-binding modules LA1-2 of p.Asp47Asn LDL-R for ApoB100 and ApoE, which was not produced by local structural changes or folding defects but as a consequence of a decreased apparent affinity for both apolipoproteins. CONCLUSION The clinical phenotype and the structural effects of p.Asp47Asn LDL-R mutation suggest that this variant associates to FH.
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Affiliation(s)
- Andrea Sánchez
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Paulina Bustos
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Paula Honorato
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Carlos F Burgos
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Natalia Barriga
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Cinthia E Jannes
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Katia Sáez
- Departamento de Estadística, Facultad de Ciencias Físicas y Matemáticas, Universidad de Concepción, Concepción, Chile
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile. Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Sylvia Asenjo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Claudia Radojkovic
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile.
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Pérez de Isla L, Arroyo-Olivares R, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Fuentes F, Mata N, Piedecausa M, Mañas MD, Sánchez Muñoz-Torrero JF, Miramontes-González JP, de Andrés R, Mauri M, Aguado R, Brea Á, Cepeda JM, Vidal-Pardo JI, Martínez-Faedo C, Barba MÁ, Argüeso R, Ruiz-Pérez E, Michán A, Arrieta F, Riestra Fernández M, Pérez L, Pinilla JM, Díaz-Soto G, Pintó X, Padró T, Badimón L, Mata P, Aguado R, Perez-Corral B, Almagro F, Alonso R, Arroyo R, Mata N, Mata P, Isla LPD, Saltijeral A, Arrieta F, Badimón L, Padró T, Barba MÁ, Brea Á, Mosquera D, Casañas M, Carbayo J, Cepeda JM, De Andrés R, Díaz JL, Díaz-Soto G, Diéguez M, Riestra M, Fuentes F, López-Miranda J, Galiana J, Mañas MD, García-Cruces J, Garrido JA, Irigoyen L, Martínez PL, Martínez-Faedo C, Suárez L, Mauri M, Borrallo RM, Mediavilla JD, Jaén F, González P, Michán A, Rubio P, Miramontes P, Morera JL, Muñiz O, González A, Pereyra F, Pérez L, Piedecausa M, Pastor J, Pinilla JM, Pintó X, Romero MJ, Ruiz E, Álvarez MP, Sáenz P, Sánchez JF, Sanz C, Vidal JI, Argüeso R, Zambón D. Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pérez de Isla L, Arroyo-Olivares R, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Fuentes F, Mata N, Piedecausa M, Mañas MD, Sánchez Muñoz-Torrero JF, Miramontes-González JP, de Andrés R, Mauri M, Aguado R, Brea Á, Cepeda JM, Vidal-Pardo JI, Martínez-Faedo C, Barba MÁ, Argüeso R, Ruiz-Pérez E, Michán A, Arrieta F, Riestra Fernández M, Pérez L, Pinilla JM, Díaz-Soto G, Pintó X, Padró T, Badimón L, Mata P. Incidence of cardiovascular events and changes in the estimated risk and treatment of familial hypercholesterolemia: the SAFEHEART registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:828-834. [PMID: 32201274 DOI: 10.1016/j.rec.2019.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES The SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. METHODS SAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. RESULTS We included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P <.001). In the last follow-up, 20.6% and 22.2% of the patients in primary and secondary prevention achieved low-density lipoprotein cholesterol values <100mg/dL and <70mg/dL, respectively. CONCLUSIONS This study was performed in the largest population of patients with FHH in Spain. We identified the incidence rate of cardiovascular events, the estimated risk of developing a cardiovascular event and its modification, the achievement of low-density lipoprotein cholesterol targets, and the therapeutic management in this population. Although the cardiovascular risk of FHH is high, appropriate treatment reduces the likelihood of an event. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Servicio de Cardiología, Hospital Clínico San Carlos, IDISSC, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
| | | | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Departamento de Nutrición, Clínica Las Condes, Santiago de Chile, Chile
| | | | | | - Daniel Zambón
- Servicio de Endocrinología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Francisco Fuentes
- Unidad de Lípidos y Arteriosclerosis, IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Nelva Mata
- Departamento de Epidemiología, Consejería de Sanidad, Madrid, Spain
| | - Mar Piedecausa
- Servicio de Medicina Interna, Hospital de Elche, Elche, Alicante, Spain
| | - M Dolores Mañas
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Marta Mauri
- Servicio de Medicina Interna, Hospital de Terrassa, Terrassa, Barcelona, Spain
| | - Rocío Aguado
- Servicio de Endocrinología, Hospital Universitario de León, León, Spain
| | - Ángel Brea
- Servicio de Medicina Interna, Hospital San Pedro, Logroño, Spain
| | - José M Cepeda
- Servicio de Medicina Interna, Hospital Comarcal Vega Baja, Orihuela, Alicante, Spain
| | | | | | - Miguel Ángel Barba
- Servicio de Medicina Interna, Hospital General de Albacete, Albacete, Spain
| | - Rosa Argüeso
- Servicio de Endocrinología, Hospital Lucus Augusti, Lugo, Spain
| | - Enrique Ruiz-Pérez
- Servicio de Endocrinología, Hospital Universitario de Burgos, Burgos, Spain
| | - Alfredo Michán
- Servicio de Medicina Interna, Hospital de Jerez de la Frontera, Cádiz, Spain
| | | | | | - Leire Pérez
- Servicio de Endocrinología, Hospital Universitario de Álava, Vitoria, Spain
| | | | - Gonzalo Díaz-Soto
- Servicio de Endocrinología, Hospital Clínico Universitario, Valladolid, Spain
| | - Xavier Pintó
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Padró
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Lina Badimón
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
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Abstract
If undiagnosed and untreated, familial hypercholesterolemia can lead to serious cardiac complications, such as premature atherosclerotic cardiovascular disease. NPs should be familiar with the clinical presentation of this inherited metabolic disease to diagnose patients as early as possible and promptly begin treatment that may include lifestyle changes, statin therapy, and/or nonstatin therapy.
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Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Atherosclerosis 2019; 277:234-255. [PMID: 30270054 DOI: 10.1016/j.atherosclerosis.2018.08.051] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. METHODS Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. RESULTS 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. CONCLUSIONS FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.
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Adults with familial hypercholesterolaemia have healthier dietary and lifestyle habits compared with their non-affected relatives: the SAFEHEART study. Public Health Nutr 2019; 22:1433-1443. [DOI: 10.1017/s1368980018003853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveHealthy lifestyle habits are the cornerstone in the management of familial hypercholesterolaemia (FH). Nevertheless, dietary studies on FH-affected populations are scarce. The present study analyses dietary habits, adherence to a Mediterranean diet pattern and physical activity in an adult population with FH and compares them with their non-affected relatives.DesignCross-sectional study.SettingData came from SAFEHEART, a nationwide study in Spain.ParticipantsIndividuals (n 3714) aged ≥18 years with a genetic diagnosis of FH (n2736) and their non-affected relatives (n 978). Food consumption was evaluated using a validated FFQ.ResultsTotal energy intake was lower in FH patients v. non-affected relatives (P<0·005). Percentage of energy from fats was also lower in the FH population (35 % in men, 36 % in women) v. those non-affected (38 % in both sexes, P<0·005), due to the lower consumption of saturated fats (12·1 % in FH patients, 13·2 % in non-affected, P<0·005). Consumption of sugars was lower in FH patients v. non-affected relatives (P<0·05). Consumption of vegetables, fish and skimmed milk was higher in the FH population (P<0·005). Patients with FH showed greater adherence to a Mediterranean diet pattern v. non-affected relatives (P<0·005). Active smoking was lower and moderate physical activity was higher in people with FH, especially women (P<0·005).ConclusionsAdult patients with FH report healthier lifestyles than their non-affected family members. They eat a healthier diet, perform more physical activity and smoke less. However, this patient group’s consumption of saturated fats and sugars still exceeds guidelines.
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Vallejo-Vaz AJ, Ray KK. Epidemiology of familial hypercholesterolaemia: Community and clinical. Atherosclerosis 2018; 277:289-297. [DOI: 10.1016/j.atherosclerosis.2018.06.855] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 01/10/2023]
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Scicali R, Di Pino A, Platania R, Purrazzo G, Ferrara V, Giannone A, Urbano F, Filippello A, Rapisarda V, Farruggia E, Piro S, Rabuazzo AM, Purrello F. Detecting familial hypercholesterolemia by serum lipid profile screening in a hospital setting: Clinical, genetic and atherosclerotic burden profile. Nutr Metab Cardiovasc Dis 2018; 28:35-43. [PMID: 28958694 DOI: 10.1016/j.numecd.2017.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is underdiagnosed and public cholesterol screening may be useful to find new subjects. In this study, we aim to investigate the prevalence of FH patients in a hospital screening program and evaluate their atherosclerotic burden using intima-media thickness (IMT). METHODS AND RESULTS We screened 1575 lipid profiles and included for genetic analysis adults with a low-density lipoprotein (LDL) cholesterol >190 mg/dL and triglycerides <200 mg/dL and first-degree child relatives with LDL cholesterol >160 mg/dL and triglycerides <200 mg/dL. The diagnosis of FH was presumed by Dutch Lipid Clinic Network (DLCN) criteria and confirmed by the presence of the genetic variant. Mean common carotid intima-media thickness (IMT) was assessed using consensus criteria. After confirming LDL cholesterol value and excluding secondary hypercholesterolemia, 56 subjects with a DLCN ≥4 performed genetic analysis. Of these, 26 had an FH genetic variant. The proportion of patients with a mutation having a DLCN score of 6-8 was 75%; in individuals with a DLCN score >8 it was 100%. Mean IMT was higher in FH patients compared to non FH (0.73 [0.61-0.83] vs 0.71 [0.60-0.75] mm, p < 0.01). Moreover, we detected two mutations not previously described. Finally, simple regression analysis showed a correlation of IMT with LDL cholesterol >190 mg/dL and corneal arcus (p < 0.01 and p < 0.001, respectively). CONCLUSIONS A hospital screening was useful to detect FH subjects with increased atherosclerosis. Also, next-generation sequencing was able to detect new FH mutations.
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Affiliation(s)
- R Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - R Platania
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - G Purrazzo
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - V Ferrara
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Giannone
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - F Urbano
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Filippello
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - V Rapisarda
- Department of Clinical and Experimental Medicine, Section of Occupational Medicine, University of Catania, Italy
| | - E Farruggia
- Occupational Medicine Division, Garibaldi Hospital of Catania, Catania, Italy
| | - S Piro
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A M Rabuazzo
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - F Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Italy.
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13
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Alonso R, Perez de Isla L, Muñiz-Grijalvo O, Diaz-Diaz JL, Mata P. Familial Hypercholesterolaemia Diagnosis and Management. Eur Cardiol 2018; 13:14-20. [PMID: 30310464 DOI: 10.15420/ecr.2018:10:2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Familial hypercholesterolaemia is the most common monogenic disorder associated with premature coronary artery disease. Mutations are most frequently found in the LDL receptor gene. Clinical criteria can be used to make the diagnosis; however, genetic testing will confirm the disorder and is very useful for cascade screening. Early identification and adequate treatment can improve prognosis, reducing negative clinical cardiovascular outcomes. Patients with familial hypercholesterolaemia are considered at high cardiovascular risk and the treatment target is LDL cholesterol <2.6 mmol/l or at least a 50 % reduction in LDL cholesterol. Patients require intensive treatment with statins and ezetimibe and/or colesevelam. Recently, proprotein convertase subtilisin/kexin type 9 inhibitors have been approved for the management of familial hypercholesterolaemia on top of statins.
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Affiliation(s)
- Rodrigo Alonso
- Department of Nutrition, Clínica Las Condes Santiago, Chile
| | - Leopoldo Perez de Isla
- Cardiology Department, Clinical Hospital San Carlos, IDISSC, Complutense University Madrid, Spain
| | | | - Jose Luis Diaz-Diaz
- Department of Internal Medicine, University A Coruña Hospital A Coruña, Spain
| | - Pedro Mata
- Spanish Familial Hypercholesterolemia Foundation Madrid, Spain
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14
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Pećin I, Hartgers ML, Hovingh GK, Dent R, Reiner Ž. Prevention of cardiovascular disease in patients with familial hypercholesterolaemia: The role of PCSK9 inhibitors. Eur J Prev Cardiol 2017. [PMID: 28644091 PMCID: PMC5574519 DOI: 10.1177/2047487317717346] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Familial hypercholesterolaemia is an autosomal dominant inherited disorder characterised by elevated low-density lipoprotein cholesterol levels and consequently an increased risk of atherosclerotic cardiovascular disease (ASCVD). Familial hypercholesterolaemia is relatively common, but is often underdiagnosed and undertreated. Cardiologists are likely to encounter many individuals with familial hypercholesterolaemia; however, patients presenting with premature ASCVD are rarely screened for familial hypercholesterolaemia and fasting lipid levels are infrequently documented. Given that individuals with familial hypercholesterolaemia and ASCVD are at a particularly high risk of subsequent cardiac events, this is a missed opportunity for preventive therapy. Furthermore, because there is a 50% chance that first-degree relatives of individuals with familial hypercholesterolaemia will also be affected by the disorder, the underdiagnosis of familial hypercholesterolaemia among patients with ASCVD is a barrier to cascade screening and the prevention of ASCVD in affected relatives. Targeted screening of patients with ASCVD is an effective strategy to identify new familial hypercholesterolaemia index cases. Statins are the standard treatment for individuals with familial hypercholesterolaemia; however, low-density lipoprotein cholesterol targets are not achieved in a large proportion of patients despite treatment. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to reduce low-density lipoprotein cholesterol levels considerably in individuals with familial hypercholesterolaemia who are concurrently receiving the maximal tolerated statin dose. The clinical benefit of PCSK9 inhibitors must, however, also be considered in terms of their cost-effectiveness. Increased awareness of familial hypercholesterolaemia is required among healthcare professionals, particularly cardiologists and primary care physicians, in order to start early preventive measures and to reduce the mortality and morbidity associated with familial hypercholesterolaemia and ASCVD.
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Affiliation(s)
- Ivan Pećin
- 1 Department of Internal Medicine, University Hospital Centre Zagreb, Croatia.,2 School of Medicine, University of Zagreb, Croatia
| | - Merel L Hartgers
- 3 Department of Vascular Medicine, Academic Medical Centre, the Netherlands
| | - G Kees Hovingh
- 3 Department of Vascular Medicine, Academic Medical Centre, the Netherlands
| | - Ricardo Dent
- 4 Amgen (Europe) GmbH, Zug, Switzerland.,5 Esperion Therapeutics Inc., Ann Arbor, USA
| | - Željko Reiner
- 1 Department of Internal Medicine, University Hospital Centre Zagreb, Croatia.,2 School of Medicine, University of Zagreb, Croatia
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15
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Consecución de objetivos terapéuticos de colesterol LDL en niños y adolescentes con hipercolesterolemia familiar. Registro longitudinal SAFEHEART. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.10.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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16
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Lázaro P, Pérez de Isla L, Watts GF, Alonso R, Norman R, Muñiz O, Fuentes F, Mata N, López-Miranda J, González-Juanatey JR, Díaz-Díaz JL, Blasco AJ, Mata P. Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia. J Clin Lipidol 2017; 11:260-271. [PMID: 28391894 DOI: 10.1016/j.jacl.2017.01.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. OBJECTIVE The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. METHODS An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. RESULTS From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. CONCLUSION The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.
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Affiliation(s)
| | - Leopoldo Pérez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Gerald F Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Nutrition, Clínica Las Condes, Santiago de Chile, Chile
| | - Richard Norman
- Department of Health Policy and Management, School of Public Health, Curtin University, Western Australia, Australia
| | - Ovidio Muñiz
- Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain
| | - Francisco Fuentes
- Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Cordoba, Spain
| | - Nelva Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Epidemiology, Madrid Health Authority, Madrid, Spain
| | - José López-Miranda
- Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain
| | | | | | | | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
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17
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Santos RD, Bourbon M, Alonso R, Cuevas A, Vasques-Cardenas NA, Pereira AC, Merchan A, Alves AC, Medeiros AM, Jannes CE, Krieger JE, Schreier L, Perez de Isla L, Magaña-Torres MT, Stoll M, Mata N, Dell Oca N, Corral P, Asenjo S, Bañares VG, Reyes X, Mata P. Clinical and molecular aspects of familial hypercholesterolemia in Ibero-American countries. J Clin Lipidol 2017; 11:160-166. [DOI: 10.1016/j.jacl.2016.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
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18
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Attainment of LDL Cholesterol Treatment Goals in Children and Adolescents With Familial Hypercholesterolemia. The SAFEHEART Follow-up Registry. ACTA ACUST UNITED AC 2016; 70:444-450. [PMID: 27913073 DOI: 10.1016/j.rec.2016.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the characteristics of persons with familial hypercholesterolemia (FH) younger than 18 years, the lipid-lowering therapy used in these patients, and the lipid goals reached in real life. Our aim was to evaluate the achievement of low-density lipoprotein cholesterol (LDL-C) treatment goals in FH patients younger than 18 years enrolled in a large national registry. METHODS We analyzed patients younger than 18 years enrolled in a large ongoing registry of molecularly-defined patients with FH in Spain. The attainment of guideline-recommended plasma LDL-C goals at entry and follow-up was analyzed in relation to the use of lipid-lowering therapy. RESULTS We enrolled 392 individuals younger than 18 years. Of these, 217 were molecularly-diagnosed FH patients and had a complete follow-up. The median follow-up time was 4.69 years (interquartile range, 2.48-6.38 years), 68.2% of FH patients were on statins, and 41.5% patients had LDL-C < 130mg/dL. Statin use was the only predictor of LDL-C goal attainment. CONCLUSIONS This study shows that a high proportion of FH patients younger than 18 years have high LDL-C levels and fail to achieve recommended LDL-C targets. Statin use was the only independent predictor of LDL-C goal achievement. No safety concerns were detected during follow-up. These results indicate that many FH patients are not adequately controlled and that there is still room for treatment improvement.
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19
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Anguita Sánchez M, Castro Conde A, Cordero Fort A, García-Moll Marimón X, Gómez Doblas JJ, González-Juanatey JR, Lidón Corbi RM, López-Sendón JL, Mostaza Prieto J, Rodríguez Padial L. Necesidades no cubiertas con el tratamiento hipolipemiante oral: documento de posición de la Sociedad Española de Cardiología. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Anguita Sánchez M, Castro Conde A, Cordero Fort A, García-Moll Marimón X, Gómez Doblas JJ, González-Juanatey JR, Lidón Corbi RM, López-Sendón JL, Mostaza Prieto J, Rodríguez Padial L. Challenges in Oral Lipid-lowering Therapy: Position Document of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2016; 69:1083-1087. [PMID: 27650859 DOI: 10.1016/j.rec.2016.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
Abstract
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups.
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Affiliation(s)
| | | | - Alberto Cordero Fort
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | | | | | - José R González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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21
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Pérez de Isla L, Alonso R, Mata N, Saltijeral A, Muñiz O, Rubio-Marin P, Diaz-Diaz JL, Fuentes F, de Andrés R, Zambón D, Galiana J, Piedecausa M, Aguado R, Mosquera D, Vidal JI, Ruiz E, Manjón L, Mauri M, Padró T, Miramontes JP, Mata P. Coronary Heart Disease, Peripheral Arterial Disease, and Stroke in Familial Hypercholesterolaemia. Arterioscler Thromb Vasc Biol 2016; 36:2004-10. [DOI: 10.1161/atvbaha.116.307514] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Objective—
Heterozygous familial hypercholesterolemia (FH) is the most common premature atherosclerotic cardiovascular disease (ASCVD)–related monogenic disorder, and it is associated with ischemic heart disease. There is limited information whether FH increases the risk of peripheral arterial and cerebrovascular disease. Our aim was to analyze ASCVD prevalence and characteristics in different arterial territories in a large FH population, to compare them with an unaffected control population and to determine which factors are associated to ASCVD.
Approach and Results—
SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) is an ongoing registry of molecularly defined patients with heterozygous FH in Spain. ASCVD in the different arterial territories was analyzed, as well as individual characteristics, genetic variables, and lipid-lowering therapies. The study recruited 4132 subjects (3745 ≥18 years); 2,752 of those enrolled were molecularly diagnosed FH cases. Median age was 44.0 years (45.9% men) and 40 years (46.6% men) in FH patients and unaffected relatives (
P
<0.001). ASCVD was present in 358 (13.0%) and 47 (4.7%) FH patients and unaffected relatives, respectively (
P
<0.001). History of premature ASCVD was more prevalent in FH patients (9.4% and 2.4% in FH patients and unaffected relatives, respectively;
P
<0.001). Coronary artery–related manifestations and peripheral artery disease were more prevalent in FH patients than in controls, but no significant differences were found for cerebrovascular events. Age, body mass index, type 2 diabetes mellitus, high blood pressure, previous use of tobacco, and lipoprotein(a) >50 mg/dL were independently associated with ASCVD.
Conclusions—
The prevalence of ASCVD is higher, and the involvement of the arterial territories is different in FH patients when compared with their unaffected relatives. Age, male sex, increased body mass index, hypertension, type 2 diabetes mellitus, smoking habit, and lipoprotein(a) >50 mg/dL were independently associated to ASCVD.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rodrigo Alonso
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Nelva Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Adriana Saltijeral
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Ovidio Muñiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Patricia Rubio-Marin
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José L. Diaz-Diaz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Francisco Fuentes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Raimundo de Andrés
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Zambón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Jesús Galiana
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Mar Piedecausa
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rocio Aguado
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Mosquera
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José I Vidal
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Enrique Ruiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Laura Manjón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Marta Mauri
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Teresa Padró
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José P. Miramontes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Pedro Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
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Pariani MJ, Knowles JW. Integration of Clinical Genetic Testing in Cardiovascular Care. CURRENT GENETIC MEDICINE REPORTS 2016. [DOI: 10.1007/s40142-016-0094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alonso R, Mata P, Alonso y Gregorio M, de Andrés R. Hipercolesterolemia familiar homocigota. Primer caso en España tratado con lomitapide, un inhibidor de la síntesis de lipoproteínas con apolipoproteína B. Med Clin (Barc) 2015; 145:229-30. [DOI: 10.1016/j.medcli.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/01/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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Watts GF, Pang J, Santos RD. Europe aspires to set the record straight on familial hypercholesterolaemia. Atherosclerosis 2015; 241:769-71. [DOI: 10.1016/j.atherosclerosis.2015.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 01/15/2023]
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