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Snel M, Descamps OS. Long-term safety and effectiveness of alirocumab and evolocumab in familial hypercholesterolemia (FH) in Belgium. Acta Cardiol 2024; 79:311-318. [PMID: 37767917 DOI: 10.1080/00015385.2023.2256182] [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: 02/03/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background: In 2019, the European Atherosclerosis Society (EAS) published updated guidelines, recommending even lower blood cholesterol targets than previously. In patients with familial hypercholesterolaemia (FH), who have very elevated blood cholesterol levels and are at ('Very') 'High risk' of atherosclerotic cardiovascular disease (ASCVD), this represents a real challenge. Anti-Proprotein convertase subtilisin/kexin type 9 monoclonal antibody (anti-PCSK9 mAb) has been commercially available for FH in Belgium since 2015. Our study aims to investigate the real-life efficacy of anti-PCSK9 mAb in FH patients. Method: We sourced patients from the EAS FH Studies Collaboration database (an international database on FH in which Belgium participates). We only retained patients using anti-PCSK9 mAb and followed at our Lipid Clinic. Results: Of the 239 subjects included in this study (mean age: 56 years), 85% were considered at 'Very High Risk' (56% with a history of ASCVD), the remaining 15% were at 'High Risk'. The PCSK9 mAb treatment reduced LDL-C levels by 54% within the first year. This reduction was maintained over the follow-up (FU) period (3.0 ± 1.8 years). The EAS targets were reached in 50% of the subjects, 93% of whom were also treated with statins. The treatment was very well tolerated. At the end of the observation period, 96% patients continued receiving PCSK9 mAb. Conclusions: Anti-PCSK9 mAb are a safe and effective therapeutic option for lowering LDL-C levels in FH patients. It allowed a significant portion of our FH patients to reach their lipid targets, mainly in those with combined therapy with statin and/or ezetimibe.
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Affiliation(s)
- Marc Snel
- Department of Internal Medicine, Centre of Medical Research of Jolimont Hospital, Pôle Hospitalier Jolimont, Haine Saint-Paul, Belgium
| | - Olivier S Descamps
- Department of Internal Medicine, Centre of Medical Research of Jolimont Hospital, Pôle Hospitalier Jolimont, Haine Saint-Paul, Belgium
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Bjune K, Halvorsen PS, Wangensteen H, Leren TP, Bogsrud MP, Strøm TB. Flavonoids regulate LDLR through different mechanisms tied to their specific structures. J Lipid Res 2024; 65:100539. [PMID: 38556050 PMCID: PMC11058080 DOI: 10.1016/j.jlr.2024.100539] [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: 12/29/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
Flavonoids, polyphenolic compounds found in plant-based diets, are associated with reduced risk of cardiovascular disease and longevity. These components are reported to reduce plasma levels of low-density lipoprotein (LDL) through an upregulation of the LDL receptor (LDLR), but the mechanism is still largely unknown. In this study, we have systematically screened the effect of 12 flavonoids from six different flavonoid subclasses on the effect on LDLR. This paper provides an in-depth analysis on how these flavonoids affect LDLR regulation and functionality. We found that most but not all of the tested flavonoids increased LDLR mRNA levels. Surprisingly, this increase was attributed to different regulatory mechanisms, such as enhanced LDLR promoter activity, LDLR mRNA stabilization, or LDLR protein stabilization, of which specific effectual parts of the flavonoid molecular structure could be assigned. These types of comparative analysis of various flavonoids enhance clarity and deepen the understanding of how the different structures of flavonoids affect LDLR regulation. Our data offer useful insights that may guide future research in developing therapeutic approaches for cardiovascular health.
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Affiliation(s)
- Katrine Bjune
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.
| | - Pia Skovholt Halvorsen
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Helle Wangensteen
- Section for Pharmaceutical Chemistry, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Martin Prøven Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Thea Bismo Strøm
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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Shi M, Wang H, Zhang X. Dyslipidemia and its associated factors among community adults located in Shangcheng district, Zhejiang province. Sci Rep 2024; 14:4268. [PMID: 38383535 PMCID: PMC10881990 DOI: 10.1038/s41598-024-54953-6] [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: 07/05/2023] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
Dyslipidemia is highly prevalent and an important modifiable risk factor of cardiovascular disease in China. However, there is little information on the dyslipidemia in Shangcheng district, eastern China. Therefore, this study aims to investigate the prevalence and associated factors of dyslipidemia among community adults in this area. A community based cross-sectional study was conducted from August 1 to November 30, 2020. The study utilized a multi-stage probability sampling method to enroll permanent residents (those who have resided in this region for 6 months or more) who were 18 years old or above. Firstly, five streets were selected randomly, and then two communities were randomly selected from each of the chosen streets, finally, systematic sampling at the household level was conducted. All participants were interviewed by trained investigators and underwent anthropometric and biochemical measurements using standard criteria. LASSO (least absolute shrinkage and selection operator) and multivariate binary logistic regression were employed to identify the factors associated with dyslipidemia. In total, 3153 participants were enrolled into this study, resulting in a response rate of 93.28%. 33 subjects were excluded because of incomplete data. Finally, 3120 participants with a mean age of 55.26 (SD = 17.97) years were included into analysis. The overall prevalence of dyslipidemia was 35.96%. 21 variables were screened to multivariate binary logistic regression through the implementation of LASSO method. The multivariate binary logistic regression analysis revealed that individuals aged 40-49 [adjusted odds ratio (aOR) = 2.197, 95% confidence interval (CI) 1.445-3.341], 50-59 (aOR = 3.213, 95% CI 2.121-4.868), 60-69 (aOR = 4.777, 95% CI 3.169-7.201), and 70 and above (aOR = 5.067, 95% CI 3.301-7.777), with an educational level of junior middle school (aOR = 1.503, 95% CI 1.013-2.229), with an educational level of senior middle school (aOR = 1.731, 95% CI 1.25-2.397), with an educational level of under graduate and above (aOR = 2.125, 95% CI 1.46-3.095), without hypertension (aOR = 0.627, 95% CI 0.517-0.76), without diabetes (aOR = 0.625, 95% CI 0.498-0.785), obesity (aOR = 1.887, 95% CI 1.13-3.154), frequent smoking (aOR = 1.727, 95% CI 1.293-2.308), frequent drinking (aOR = 0.738, 95% CI 0.556-0.981), without family history of CVD (aOR = 0.505, 95% CI 0.342-0.744), and daily seafood intakes between 42.87 and 71.43 g (aOR = 1.31, 95% CI 1.05-1.634) were significantly associated with dyslipidemia. Gender-stratified analyses showed that aged 70 and above (aOR = 2.127, 95% CI 1.195-3.785), without hypertension (aOR = 0.643, 95% CI 0.484-0.854), without diabetes (aOR = 0.603, 95% CI 0.436-0.834), without CVD (aOR = 0.494, 95% CI 0.309-0.791), without stroke (aOR = 1.767, 95% CI 1.036-3.012), frequent smoking (aOR = 1.951, 95% CI 1.415-2.691), former smoking (aOR = 1.703, 95% CI 1.16-2.502) were significantly associated with dyslipidemia in male. Aged 40-49 (aOR = 3.51, 95% CI 1.789-6.887), 50-59 (aOR = 7.03, 95% CI 3.584-13.791), 60-69 (aOR = 15.728, 95% CI 8.005-30.9), and 70 and above (aOR = 12.929, 95% CI 6.449-25.921), with an educational level of senior middle school (aOR = 1.926, 95% CI 1.288-2.881), with an educational level of under graduate and above (aOR = 2.91, 95% CI 1.75-4.837), without hypertension (aOR = 0.592, 95% CI 0.45-0.779), without diabetes (aOR = 0.619, 95% CI 0.443-0.865), without family history of CVD (aOR = 0.429, 95% CI 0.251-0.733), without family history of cancer (aOR = 0.542, 95% CI 0.316-0.929), daily vegetables intakes between 251 and 500 g (aOR = 0.734, 95% CI 0.545-0.99), daily seafood intakes between 42.87 and 71.43 g (aOR = 1.421, 95% CI 1.04-1.942) were significantly associated with dyslipidemia in female. In the age-stratified analyses, it was found that without hypertension (aOR = 0.522, 95% CI 0.375-0.727) or diabetes (aOR = 0.445, 95% CI 0.267-0.744), obesity (aOR = 2.956, 95% CI 1.258-6.942), frequent smoking (aOR = 1.826, 95% CI 1.196-2.787), showed a significant association with dyslipidemia in individuals aged younger than 60 years. Female (aOR = 1.764, 95% CI 1.316-2.366), with an educational level of junior middle school (aOR = 1.793, 95% CI 1.169-2.749), with an educational level of senior middle school (aOR = 2.002, 95% CI 1.406-2.849), with an educational level of under graduate and above (aOR = 2.849, 95% CI 1.791-4.532), without hypertension (aOR = 0.604, 95% CI 0.477-0.764), without diabetes (aOR = 0.63, 95% CI 0.486-0.818), without CVD (aOR = 0.66, 95% CI 0.473-0.921), frequent smoking (aOR = 1.513, 95% CI 1.02-2.245), former smoking (aOR = 1.647, 95% CI 1.089-2.491), without family history of CVD (aOR = 0.406, 95% CI 0.239-0.692), daily seafood intakes between 42.87 and 71.43 g (aOR = 1.376, 95% CI 1.018-1.859) were significantly associated with dyslipidemia among participants aged 60 and above. Dyslipidemia is a prevalent condition observed among adults residing in Shangcheng district. Risk factors such as gender, age, education, hypertension, diabetes, cardiovascular disease, stroke, obesity, smoking, drinking, family history of cardiovascular disease, family history of cancer, daily vegetables intakes, daily seafood intakes were associated with dyslipidemia and varied across population of different gender and age groups. Enhancing education and promoting self-awareness regarding the necessity of behavior modification and regular medication intake would be beneficial in reducing the occurrence of dyslipidemia among adults in the Shangcheng district.
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Affiliation(s)
- Mingming Shi
- Center for Disease Control and Prevention of Shangcheng District, Hangzhou, Zhejiang, China
| | - Hui Wang
- Center for Disease Control and Prevention of Shangcheng District, Hangzhou, Zhejiang, China
| | - Xiao Zhang
- Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
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4
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Konečná K, Zapletalová P, Freiberger T, Tichý L. LDLR gene rearrangements in Czech FH patients likely arise from one mutational event. Lipids Health Dis 2024; 23:36. [PMID: 38308247 PMCID: PMC10835926 DOI: 10.1186/s12944-024-02013-3] [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: 10/03/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Large deletions and duplications within the low-density lipoprotein receptor (LDLR) gene make up approximately 10% of LDLR pathogenic variants found in Czech patients with familial hypercholesterolemia. The goal of this study was to test the hypothesis that all probands with each rearrangement share identical breakpoints inherited from a common ancestor and to determine the role of Alu repetitive elements in the generation of these rearrangements. METHODS The breakpoint sequence was determined by PCR amplification and Sanger sequencing. To confirm the breakpoint position, an NGS analysis was performed. Haplotype analysis of common LDLR variants was performed using PCR and Sanger sequencing. RESULTS The breakpoints of 8 rearrangements within the LDLR gene were analysed, including the four most common LDLR rearrangements in the Czech population (number of probands ranging from 8 to 28), and four less common rearrangements (1-4 probands). Probands with a specific rearrangement shared identical breakpoint positions and haplotypes associated with the rearrangement, suggesting a shared origin from a common ancestor. All breakpoints except for one were located inside an Alu element. In 6 out of 8 breakpoints, there was high homology (≥ 70%) between the two Alu repeats in which the break occurred. CONCLUSIONS The most common rearrangements of the LDLR gene in the Czech population likely arose from one mutational event. Alu elements likely played a role in the generation of the majority of rearrangements inside the LDLR gene.
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Affiliation(s)
- Kateřina Konečná
- Centre of Molecular Biology and Genetics, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Kamenice 5, Brno, 625 00, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Petra Zapletalová
- Centre of Molecular Biology and Genetics, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic
| | - Tomáš Freiberger
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
- Centre for Cardiovascular Surgery and Transplantation, Pekařská 53, 656 91, Brno, Czech Republic
| | - Lukáš Tichý
- Centre of Molecular Biology and Genetics, University Hospital Brno, Jihlavská 20, Brno, 625 00, Czech Republic.
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5
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Walters NL, Lindsey-Mills ZT, Brangan A, Savage SK, Schmidlen TJ, Morgan KM, Tricou EP, Betts MM, Jones LK, Sturm AC, Campbell-Salome G. Facilitating family communication of familial hypercholesterolemia genetic risk: Assessing engagement with innovative chatbot technology from the IMPACT-FH study. PEC INNOVATION 2023; 2:100134. [PMID: 37214500 PMCID: PMC10194298 DOI: 10.1016/j.pecinn.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 05/24/2023]
Abstract
Objective To assess use of two web-based conversational agents, the Family Sharing Chatbot (FSC) and One Month Chatbot (OMC), by individuals with familial hypercholesterolemia (FH). Methods FSC and OMC were sent using an opt-out methodology to a cohort of individuals receiving a FH genetic result. Data from 7/1/2021 through 5/12/2022 was obtained from the electronic health record and the chatbots' HIPAA-secure web portal. Results Of 175 subjects, 21 (12%) opted out of the chatbots. Older individuals were more likely to opt out. Most (91/154, 59%) preferred receiving chatbots via the patient EHR portal. Seventy-five individuals (49%) clicked the FSC link, 62 (40%) interacted, and 36 (23%) shared a chatbot about their FH result with at least one relative. Ninety-two of the subjects received OMC, 22 (23%) clicked the link and 20 (21%) interacted. Individuals who shared were majority female and younger on average than the overall cohort. Reminders tended to increase engagement. Conclusion Results demonstrate characteristics relevant to chatbot engagement. Individuals may be more inclined to receive chatbots if integrated within the patient EHR portal. Frequent reminders can potentially improve chatbot utilization. Innovation FSC and OMC employ innovative digital health technology that can facilitate family communication about hereditary conditions.
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Affiliation(s)
| | | | - Andrew Brangan
- Geisinger, 100 N. Academy Avenue, Danville, PA 17822, USA
| | | | | | | | - Eric P. Tricou
- Geisinger, 100 N. Academy Avenue, Danville, PA 17822, USA
- Family Heart Foundation, 959 East Walnut Street Suite 220, Pasadena, CA 91106, USA
| | - Megan M. Betts
- Geisinger, 100 N. Academy Avenue, Danville, PA 17822, USA
- WellSpan Health, 45 Monument Road Suite 200, York 17403, PA, USA
| | - Laney K. Jones
- Geisinger, 100 N. Academy Avenue, Danville, PA 17822, USA
| | - Amy C. Sturm
- Geisinger, 100 N. Academy Avenue, Danville, PA 17822, USA
- 23andMe, 223 N Mathilda Avenue, Sunnyvale, CA 94086, USA
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Schreuder MM, Hamkour S, Siegers KE, Holven KB, Johansen AK, van de Ree MA, Imholz B, Boersma E, Louters L, Bogsrud MP, Retterstøl K, Visseren FLJ, Roeters van Lennep JE, Koopal C. LDL cholesterol targets rarely achieved in familial hypercholesterolemia patients: A sex and gender-specific analysis. Atherosclerosis 2023; 384:117117. [PMID: 37080805 DOI: 10.1016/j.atherosclerosis.2023.03.022] [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: 09/25/2022] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND AIMS Despite lipid lowering therapy (LLT), reaching LDL-C targets in patients with familial hypercholesterolemia (FH) remains challenging. Our aim was to determine attainment of LDL-C target levels and reasons for not reaching these in female and male FH patients. METHODS We performed a cross-sectional study of heterozygous FH patients in five hospitals in the Netherlands and Norway. Clinical characteristics and information about LLT, lipid levels and reasons for not being on LDL-C treatment target were retrospectively collected from electronic medical records. RESULTS We studied 3178 FH patients (53.9% women), median age 48.0 (IQR 34.0-59.9) years. Median LDL-C before treatment and on-treatment was higher in women compared to men (6.2 (IQR 5.1-7.3) and 6.0 (IQR 4.9-7.2) mmol/l (p=0.005) and 3.0 (IQR 2.4-3.8) and 2.8 (IQR 2.3-3.5) mmol/L (p<0.001)), respectively. A minority of women (26.9%) and men (28.9%) reached LDL-C target. In patients with CVD, 17.2% of women and 25.8% of men reached LDL-C target. Women received less often high-intensity statins and ezetimibe. Most common reported reasons for not achieving the LDL-C target were insufficient effect of maximum LLT (women 17.3%, men 24.3%) and side effects (women 15.2%, men 8.6%). CONCLUSIONS In routine practice, only a minority of women and men with FH achieved their LDL-C treatment target. Extra efforts have to be made to provide FH patients with reliable information on the safety of statins and their long-term effects on CVD risk reduction. If statin treatment is insufficient, alternative lipid lowering therapies such as ezetimibe or PCSK9-inhibitors should be considered.
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Affiliation(s)
- M M Schreuder
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - S Hamkour
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K E Siegers
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K B Holven
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; National Advisory Unit on FH, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Aker, Oslo, Norway
| | - A K Johansen
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; National Advisory Unit on FH, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Aker, Oslo, Norway
| | - M A van de Ree
- Department of Internal Medicine, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B Imholz
- Department of Internal Medicine, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L Louters
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital Ullevål, Oslo, Norway
| | - K Retterstøl
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; The Lipid Clinic, Oslo University Hospital, Norway
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - C Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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7
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Guerin A, Iatan I, Ruel I, Ngufor LF, Genest J. Genetic testing for familial hypercholesterolemia in Quebec, Canada: a single-centre retrospective cohort study. CMAJ Open 2023; 11:E754-E764. [PMID: 37607748 PMCID: PMC10449021 DOI: 10.9778/cmajo.20220108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is associated with premature atherosclerotic cardiovascular disease caused by elevated low-density lipoprotein cholesterol (LDL-C) levels. We determined the impact of a full next-generation sequencing (NGS) genetic panel on reclassification of patients with a clinical diagnosis of FH in Quebec compared to the partial genetic panel currently offered by the Quebec Ministère de la Santé et des Services sociaux (Ministry of Health and Social Services) (MSSS), which includes 11 variants that are common in French Canadians. METHODS We conducted a retrospective cohort study in a subgroup of patients in the Canadian FH Registry seen at the McGill University Health Centre Preventive Cardiology/Lipid Clinic, Montréal, between September 2017 and September 2021 who were clinically diagnosed with severe hypercholesterolemia, probable FH or definite FH according to the Canadian definition of FH. Next-generation sequencing of the LDLR, APOB and PCSK9 genes, and multiplex ligation-dependent probe amplification of the LDLR gene to detect genetic variants, were performed. RESULTS Among 335 consecutive patients with heterozygous FH (184 men [54.9%] and 151 women [45.1%]), the baseline LDL-C level was 6.96 (standard deviation 1.79) mmol/L. Patients identified through cascade screening were 11 years younger on average than index patients, and smaller proportions presented to the clinic with cardiovascular risk factors. A pathogenic FH variant was identified in 169 (73.8%) of the 229 patients who underwent genetic testing; the majority had variants in the LDLR (146 [86.4%]) or APOB (24 [14.2%]) gene. The genetic panel offered by the MSSS accounted for only 48% of the variants identified with the full NGS panel. Of the 229 patients, 90 (39.3%, 95% confidence interval 32.9%-46.0%) were reclassified from a clinical diagnosis of probable FH to definite FH after genetic screening with a full FH panel. INTERPRETATION Genetic testing in patients suspected of having FH provided diagnostic certainty and permitted many patients with a clinical diagnosis of probable FH to be reclassified as having definite FH. Genetic screening allows for increased identification of patients with FH and may therefore help reduce the burden of cardiovascular disease and mortality rates among Canadians with FH. Trial registration: ClinicalTrials.gov, no. NCT02009345.
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Affiliation(s)
- Amanda Guerin
- Research Institute of the McGill University Health Centre (Guerin, Ruel, Fri Ngufor, Genest), Montréal, Que.; Centre for Heart Lung Innovation (Iatan), Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC
| | - Iulia Iatan
- Research Institute of the McGill University Health Centre (Guerin, Ruel, Fri Ngufor, Genest), Montréal, Que.; Centre for Heart Lung Innovation (Iatan), Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC
| | - Isabelle Ruel
- Research Institute of the McGill University Health Centre (Guerin, Ruel, Fri Ngufor, Genest), Montréal, Que.; Centre for Heart Lung Innovation (Iatan), Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC
| | - Linda Fri Ngufor
- Research Institute of the McGill University Health Centre (Guerin, Ruel, Fri Ngufor, Genest), Montréal, Que.; Centre for Heart Lung Innovation (Iatan), Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC
| | - Jacques Genest
- Research Institute of the McGill University Health Centre (Guerin, Ruel, Fri Ngufor, Genest), Montréal, Que.; Centre for Heart Lung Innovation (Iatan), Healthy Heart Program Prevention Clinic, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC
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8
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Hyperlipidemia and Cardiovascular Risk in Children and Adolescents. Biomedicines 2023; 11:biomedicines11030809. [PMID: 36979789 PMCID: PMC10045454 DOI: 10.3390/biomedicines11030809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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.
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Bellows BK, Khera AV, Zhang Y, Ruiz-Negrón N, Stoddard HM, Wong JB, Kazi DS, de Ferranti SD, Moran AE. Estimated Yield of Screening for Heterozygous Familial Hypercholesterolemia With and Without Genetic Testing in US Adults. J Am Heart Assoc 2022; 11:e025192. [PMID: 35583136 PMCID: PMC9238728 DOI: 10.1161/jaha.121.025192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heterozygous familial hypercholesterolemia (FH) is a common genetic disorder causing premature cardiovascular disease. Despite this, there is no national screening program in the United States to identify individuals with FH or likely pathogenic FH genetic variants. Methods and Results The clinical characteristics and FH variant status of 49 738 UK Biobank participants were used to develop a regression model to predict the probability of having any FH variants. The regression model and modified Dutch Lipid Clinic Network criteria were applied to 39 790 adult participants (aged ≥20 years) in the National Health and Nutrition Examination Survey to estimate the yield of FH screening programs using Dutch Lipid Clinic Network clinical criteria alone (excluding genetic variant status), genetic testing alone, or combining clinical criteria with genetic testing. The regression model accurately predicted FH variant status in UK Biobank participants (observed prevalence, 0.27%; predicted, 0.26%; area under the receiver-operator characteristic curve, 0.88). In the National Health and Nutrition Examination Survey, the estimated yield per 1000 individuals screened (95% CI) was 3.7 (3.0-4.6) FH cases with the Dutch Lipid Clinic Network clinical criteria alone, 3.8 (2.7-5.1) cases with genetic testing alone, and 6.6 (5.3-8.0) cases by combining clinical criteria with genetic testing. In young adults aged 20 to 39 years, using clinical criteria alone was estimated to yield 1.3 (95% CI, 0.6-2.5) FH cases per 1000 individuals screened, which was estimated to increase to 4.2 (95% CI, 2.6-6.4) FH cases when combining clinical criteria with genetic testing. Conclusions Screening for FH using a combination of clinical criteria with genetic testing may increase identification and the opportunity for early treatment of individuals with FH.
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Affiliation(s)
| | - Amit V Khera
- Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Cardiovascular Disease Initiative Broad Institute of MIT and Harvard Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
| | - Yiyi Zhang
- Department of Medicine Columbia University New York NY
| | | | | | - John B Wong
- Department of Medicine Tufts Medical Center Boston MA
| | - Dhruv S Kazi
- Department of Medicine Harvard Medical School Boston MA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA
| | - Sarah D de Ferranti
- Department of Pediatrics Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Boston MA
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10
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Sniderman AD, Glavinovic T, Thanassoulis G. Key Questions About Familial Hypercholesterolemia: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:1023-1031. [PMID: 35272797 DOI: 10.1016/j.jacc.2022.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/16/2022]
Abstract
Familial hypercholesterolemia (FH) is characterized as a monogenic, autosomal dominant disorder, producing severe hypercholesterolemia within families due to causal variants within genes regulating the low-density lipoprotein receptor pathway. Demonstration of a causal variant is widely accepted as evidence of substantially higher cardiovascular risk. However, recent large-scale population studies challenge this characterization of FH, which appears to account for only a minor portion of those with severe hypercholesterolemia. Moreover, a substantial portion of FH variant positive patients do not have marked hypercholesterolemia. These discordances raise doubt as to how FH should be defined and how the concentration of low-density lipoprotein in plasma is regulated in individuals with and without FH. Moreover, review of the evidence suggests the impact of an FH causal variant on cardiovascular risk may be less than previously accepted and that all patients with severe hypercholesterolemia should be prioritized for therapy and family screening.
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Affiliation(s)
- Allan D Sniderman
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Tamara Glavinovic
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - George Thanassoulis
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. https://twitter.com/thanassoulisMD
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11
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Kataoka Y, Funabashi S, Doi T, Harada-Shiba M. How Can We Identify Very High-Risk Heterozygous Familial Hypercholesterolemia? J Atheroscler Thromb 2022; 29:795-807. [PMID: 35022364 PMCID: PMC9174089 DOI: 10.5551/jat.rv17063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Heterozygous familial hypercholesterolemia (HeFH) is a genetic disorder that elevates low-density lipoprotein cholesterol and increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). However, despite their atherogenic lipid profiles, the cardiovascular risk of HeFH varies in each individual. Their variety of phenotypic features suggests the need for better risk stratification to optimize their therapeutic management. The current review summarizes three potential approaches, including (1) definition of familial hypercholesterolemia (FH)-related risk scores, (2) genetic analysis, and (3) biomarkers. The International Atherosclerosis Society has recently proposed a definition of severe FH to identify very high-risk HeFH subjects according to their clinical characteristics. Furthermore, published studies have shown the association of FH-related genetic phenotypes with ASCVD, which indicates the genetic analysis’s potential to evaluate individual cardiovascular risks. Biomarkers reflecting disease activity have been considered to predict the formation of atherosclerosis and the occurrence of ASCVD in HeFH subjects. Incorporating these risk stratifications will be expected to allocate adequate intensity of lipid-lowering therapies in HeFH subjects, which ultimately improves cardiovascular outcomes.
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Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre
| | | | - Takahito Doi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre.,Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte.,Department of Clinical Medicine, University of Copenhagen
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral & Cardiovascular Centre
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12
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van der Laarse A, Cobbaert CM. Biochemical risk factors of atherosclerotic cardiovascular disease: from a narrow and controversial approach to an integral approach and precision medicine. Expert Rev Cardiovasc Ther 2022; 19:1085-1096. [PMID: 34937476 DOI: 10.1080/14779072.2021.2022475] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Guidelines of management of dyslipidemias and prevention of cardiovascular disease (CVD) are based on firm scientific evidence obtained by randomized controlled trials (RCTs). However, the role of elevated low-density lipoprotein-cholesterol (LDL-C)as a risk factor of CVD and therapies to lower LDL-C are frequently disputed by colleagues who disagree with the conclusions of the RCTs published. This review focuses on this dispute, and evaluates the current approach of management of dyslipidemias and CVD prevention to find modern alternatives for more precise diagnosis and therapy of dyslipidemic patients. AREAS COVERED Recent interest in lipoprotein(a) (Lp(a)) and remnants lipoproteins and in therapies that do not influence LDL-C levels primarily, such as anti-inflammatory drugs and icosapent ethyl, has revitalized our concern to optimize the care for patients with increased CVD risk without focusing simply on reduction of LDL-C by therapy with statins, ezitemibe, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors. EXPERT OPINION The limited characterization of study populations by measurement of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) followed by measurement or calculation of LDL-C should be extended by a more integral approach in order to realize precision diagnostics and precision medicine, for the sake of personalized patient care.
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Affiliation(s)
- Arnoud van der Laarse
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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13
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Izar MCDO, Giraldez VZR, Bertolami A, Santos Filho RDD, Lottenberg AM, Assad MHV, Saraiva JFK, Chacra APM, Martinez TLR, Bahia LR, Fonseca FAH, Faludi AA, Sposito AC, Chagas ACP, Jannes CE, Amaral CK, Araújo DBD, Cintra DE, Coutinho EDR, Cesena F, Xavier HT, Mota ICP, Giuliano IDCB, Faria Neto JR, Kato JT, Bertolami MC, Miname MH, Castelo MHCG, Lavrador MSF, Machado RM, Souza PGD, Alves RJ, Machado VA, Salgado Filho W. Update of the Brazilian Guideline for Familial Hypercholesterolemia - 2021. Arq Bras Cardiol 2021; 117:782-844. [PMID: 34709306 PMCID: PMC8528358 DOI: 10.36660/abc.20210788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Viviane Zorzanelli Rocha Giraldez
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | | | - Ana Maria Lottenberg
- Hospital Israelita Albert Einstein (HIAE) - Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10), São Paulo, São Paulo, SP - Brasil
| | | | | | - Ana Paula M Chacra
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | - Cinthia Elim Jannes
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Fernando Cesena
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Marcio Hiroshi Miname
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Maria Helane Costa Gurgel Castelo
- Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
- Hospital do Coração de Messejana, Fortaleza, CE - Brasil
- Professora da Faculdade Unichristus, Fortaleza, CE - Brasil
| | - Maria Sílvia Ferrari Lavrador
- Hospital Israelita Albert Einstein (HIAE) - Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP - Brasil
| | - Roberta Marcondes Machado
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10), São Paulo, São Paulo, SP - Brasil
| | - Patrícia Guedes de Souza
- Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia (UFBA), Salvador, BA - Brasil
| | | | | | - Wilson Salgado Filho
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
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14
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Elbadawi A, Elgendy IY, Omer M, Abdelazeem M, Nambi V, Krittanawong C, Hira RS, Tamis-Holland J, Ballantyne C, Jneid H. Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia. Am J Med 2021; 134:992-1001.e4. [PMID: 33872584 DOI: 10.1016/j.amjmed.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. METHODS We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia. RESULTS The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64). CONCLUSION In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Omer
- Division of Cardiology, Mayo Clinic, Rochester, Minn
| | - Mohamed Abdelazeem
- Department of Internal Medicine, St. Elizabeth's Medical Center, Brighton, Mass
| | - Vijay Nambi
- Section of Cardiology, Baylor School of Medicine, Houston, Tex
| | | | - Ravi S Hira
- Pulse Heart Institute, Tacoma, Wash; Foundation for Health Care Quality, Seattle, Wash
| | | | | | - Hani Jneid
- Section of Cardiology, Baylor School of Medicine, Houston, Tex.
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15
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Soukup J, Zierhut HA, Ison HE. Universal Cholesterol Screening among Pediatric Primary Care Providers within California and Minnesota: A Qualitative Assessment of Barriers and Facilitators. J Pediatr 2021; 233:175-182.e2. [PMID: 33662342 DOI: 10.1016/j.jpeds.2021.02.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess current pediatric cholesterol screening practices, and attitudes, among pediatric primary care providers (PCPs) via qualitative semistructured interviews designed to identify barriers and facilitators to universal cholesterol screening practices recommended by the National Heart Blood and Lung Institute and the American Academy of Pediatrics. STUDY DESIGN An online survey and subsequent 30-minute semistructured phone interview were completed with PCPs from regions in Northern California and Minnesota (survey n = 25, interview n = 12). Interviews were qualitatively analyzed using the consolidated framework for implementation research to categorize barriers, facilitators, and strategies to increase pediatric cholesterol screening among PCPs. RESULTS PCPs from California (n = 8) and Minnesota (n = 4) consistently identified cost of cholesterol screening, particularly the cost of time due to competing visit priorities, as a barrier. A supportive learning environment, feelings of self-efficacy, access to resources, and well-established clinical networks with specialists (eg, cardiologists) were facilitators to screening. The perceived level of endorsement behind cholesterol screening within the clinic, perceived validity of national guidelines, and ability to adapt guidelines to existing clinical workflow were notable differentiators between high vs low self-reported screen rates. CONCLUSIONS Findings of this study suggest that efforts to increase universal pediatric cholesterol screening will likely require the development of strategies to increase provider education about the long-term benefits of cholesterol screening (knowledge and beliefs), and ensuring providers feel supported and empowered when assessing/acting on the results of this screening (self-efficacy, engaging leaders, networks, and communication).
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Affiliation(s)
- Jenna Soukup
- Department of Genetics, Cell Biology, & Development, University of Minnesota - Twin Cities, Minneapolis, MN
| | - Heather A Zierhut
- Department of Genetics, Cell Biology, & Development, University of Minnesota - Twin Cities, Minneapolis, MN
| | - Hannah E Ison
- Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, Stanford, CA; Division of Cardiology in the Department of Pediatrics, Stanford Medicine, Stanford, CA.
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16
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Meshkov AN, Ershova AI, Kiseleva AV, Shalnova SA, Drapkina OM, Boytsov SA. The Prevalence of Heterozygous Familial Hypercholesterolemia in Selected Regions of the Russian Federation: The FH-ESSE-RF Study. J Pers Med 2021; 11:464. [PMID: 34074024 PMCID: PMC8225162 DOI: 10.3390/jpm11060464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Heterozygous familial hypercholesterolemia (HeFH) is one of the most common genetic conditions but remains substantially underdiagnosed. The aim of our study was to investigate the prevalence of HeFH in the population of 11 different regions of Russia. Individuals were selected from the Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study. All participants who had low-density lipoprotein cholesterol (LDL-C) higher than 4.9 mmol/L, or LDL-C lower than 4.9 mmol/L, but had statin therapy, were additionally examined by FH experts. FH was diagnosed using the Dutch Lipid Clinic Network criteria, incorporating genetic testing. HeFH prevalence was assessed for 18,142 participants. The prevalence of patients with definite or probable HeFH combined was 0.58% (1 in 173). A total of 16.1% of patients with definite or probable HeFH had tendon xanthomas; 36.2% had mutations in one of the three genes; 45.6% of FH patients had coronary artery disease; 63% of HeFH patients received statins; one patient received an additional PCSK9 inhibitor; no patients received ezetimibe. Only 3% of patients reached the LDL-C goal based on 2019 ESC/EAS guidelines. Underdiagnosis and undertreatment of FH in Russia underline the need for the intensification of FH detection with early and aggressive cholesterol-lowering treatment.
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Affiliation(s)
- Alexey N. Meshkov
- Federal State Institution, National Medical Research Center for Therapy and Preventive Medicine, Min-istry of Healthcare of the Russian Federation, Petroverigsky per., 10, bld. 3, 101000 Moscow, Russia; (A.I.E.); (A.V.K.); (S.A.S.); (O.M.D.)
| | - Alexandra I. Ershova
- Federal State Institution, National Medical Research Center for Therapy and Preventive Medicine, Min-istry of Healthcare of the Russian Federation, Petroverigsky per., 10, bld. 3, 101000 Moscow, Russia; (A.I.E.); (A.V.K.); (S.A.S.); (O.M.D.)
| | - Anna V. Kiseleva
- Federal State Institution, National Medical Research Center for Therapy and Preventive Medicine, Min-istry of Healthcare of the Russian Federation, Petroverigsky per., 10, bld. 3, 101000 Moscow, Russia; (A.I.E.); (A.V.K.); (S.A.S.); (O.M.D.)
| | - Svetlana A. Shalnova
- Federal State Institution, National Medical Research Center for Therapy and Preventive Medicine, Min-istry of Healthcare of the Russian Federation, Petroverigsky per., 10, bld. 3, 101000 Moscow, Russia; (A.I.E.); (A.V.K.); (S.A.S.); (O.M.D.)
| | - Oxana M. Drapkina
- Federal State Institution, National Medical Research Center for Therapy and Preventive Medicine, Min-istry of Healthcare of the Russian Federation, Petroverigsky per., 10, bld. 3, 101000 Moscow, Russia; (A.I.E.); (A.V.K.); (S.A.S.); (O.M.D.)
| | - Sergey A. Boytsov
- National Medical Research Center for Cardiology, 3-ya Cherepkovskaya Street, 15A, 121552 Moscow, Russia;
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17
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Climent E, Marco-Benedí V, Benaiges D, Pintó X, Suárez-Tembra M, Plana N, Lafuente H, Ortega-Martínez de Victoria E, Brea-Hernando Á, Vila À, Civeira F, Pedro-Botet J. Impact of statin therapy on LDL and non-HDL cholesterol levels in subjects with heterozygous familial hypercholesterolaemia. Nutr Metab Cardiovasc Dis 2021; 31:1594-1603. [PMID: 33744038 DOI: 10.1016/j.numecd.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular risk in heterozygous familial hypercholesterolaemia (HeFH) is driven by LDL cholesterol levels. Since lipid response to statin therapy presents individual variation, this study aimed to compare mean LDL and non-HDL cholesterol reductions and their variability achieved with different types and doses of the most frequently prescribed statins. METHODS AND RESULTS Among primary hypercholesterolaemia cases on the Spanish Arteriosclerosis Society registry, 2894 with probable/definite HeFH and complete information on drug therapy and lipid profile were included. LDL cholesterol reduction ranged from 30.2 ± 17.0% with simvastatin 10 mg to 48.2 ± 14.7% with rosuvastatin 40 mg. After the addition of ezetimibe, an additional 26, 24, 21 and 24% reduction in LDL cholesterol levels was obtained for rosuvastatin, 5, 10, 20 and 40 mg, respectively. Subjects with definite HeFH and a confirmed genetic mutation had a more discrete LDL cholesterol reduction compared to definite HeFH subjects with no genetic mutation. A suboptimal response (<15% or <30% reduction in LDL cholesterol levels, respectively with low-/moderate-intensity and high-intensity statin therapy) was observed in 13.5% and, respectively, 20.3% of the subjects. CONCLUSION According to the LDL cholesterol reduction in HeFH patients, the ranking for more to less potent statins was rosuvastatin, atorvastatin and simvastatin; however, at maximum dosage, atorvastatin and rosuvastatin were nearly equivalent. HeFH subjects with positive genetic diagnosis had a lower lipid-lowering response. Approximately 1 in 5 patients on high-intensity statin therapy presented a suboptimal response.
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Affiliation(s)
- Elisenda Climent
- Endocrinology and Nutrition Department. Hospital Del Mar; Paseo Marítimo, 25-29; E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona. Campus Universitari Mar; Dr. Aiguader, 80; E-08003, Barcelona, Spain
| | - Victoria Marco-Benedí
- Lipid Unit, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - David Benaiges
- Endocrinology and Nutrition Department. Hospital Del Mar; Paseo Marítimo, 25-29; E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona. Campus Universitari Mar; Dr. Aiguader, 80; E-08003, Barcelona, Spain; Institut Hospital Del Mar D'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80; E-08003, Barcelona, Spain
| | - Xavier Pintó
- Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital de Bellvitge, CIBEROBN, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Núria Plana
- Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan. IISPV, CIBERDEM, Universitat Rovira i Virgili, Reus, Spain
| | - Hannia Lafuente
- Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital de Bellvitge, CIBEROBN, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ángel Brea-Hernando
- Lipid Unit, Department of Internal Medicine, Hospital San Pedro, Logroño, Spain
| | - Àlex Vila
- Lipid Unit, Department of Internal Medicine, Hospital de Figueres, Figueres, Girona, Spain
| | - Fernando Civeira
- Lipid Unit, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Juan Pedro-Botet
- Endocrinology and Nutrition Department. Hospital Del Mar; Paseo Marítimo, 25-29; E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona. Campus Universitari Mar; Dr. Aiguader, 80; E-08003, Barcelona, Spain; Institut Hospital Del Mar D'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80; E-08003, Barcelona, Spain.
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18
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Leren TP, Bogsrud MP. Molecular genetic testing for autosomal dominant hypercholesterolemia in 29,449 Norwegian index patients and 14,230 relatives during the years 1993-2020. Atherosclerosis 2021; 322:61-66. [PMID: 33740630 DOI: 10.1016/j.atherosclerosis.2021.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS In this study, we present the status regarding molecular genetic testing for mutations in the genes encoding the low density lipoprotein receptor (LDLR), apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9) as causes of autosomal dominant hypercholesterolemia (ADH) in Norway. METHODS We have extracted data from the laboratory information management system at Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital for the period 1993-2020. This laboratory is the sole laboratory performing molecular genetic testing for ADH in Norway. RESULTS A total of 29,449 unrelated hypercholesterolemic patients have been screened for mutations in the LDLR gene, in the APOB gene and in the PCSK9 gene. Of these, 2818 (9.6%) were heterozygotes and 11 were homozygotes or compound heterozygotes. Most of the 264 different mutations identified were found in the LDLR gene. Only two and three mutations were found in the APOB gene or in the PCSK9 gene, respectively. Several founder mutations were identified. After testing of 14,230 family members, a total of 8811 heterozygous patients have been identified. Of these, 94.0% had a mutation in the LDLR gene, 5.4% had a mutation in the APOB gene and 0.6% had a mutation in the PCSK9 gene. CONCLUSIONS A large proportion of Norwegian ADH patients have been provided with a molecular genetic diagnosis. Norway is probably only second to the Netherlands in this respect. A molecular genetic diagnosis may form the basis for starting proper preventive measures and for identifying affected family members by cascade genetic screening.
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Affiliation(s)
- Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.
| | - Martin Prøven Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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19
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Groth NA, Stone NJ, Benziger CP. Cardiology clinic visit increases likelihood of evidence-based cholesterol prescribing in severe hypercholesterolemia. Clin Cardiol 2020; 44:186-192. [PMID: 33355940 PMCID: PMC7852174 DOI: 10.1002/clc.23521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background Patients with phenotypic severe hypercholesterolemia (SH), low‐density lipoprotein‐cholesterol (LDL‐c) ≥ 190 mg/dl, atherosclerotic cardiovascular disease (ASCVD) or adults 40–75 years with diabetes with risk factors or 10‐year ASCVD risk ≥20% benefit from maximally tolerated statin therapy. Rural patients have decreased access to specialty care, potentially limiting appropriate treatment. Hypothesis Prior visit with cardiology will improve treatment of severe hypercholesterolemia. Methods We used an electronic medical record‐based SH registry defined as ever having an LDL‐c ≥ 190 mg/dl since January 1, 2000 (n = 18 072). We excluded 3205 (17.7%) patients not alive or age 20–75 years. Patients defined as not seen by cardiology if they had no visit within the past 3 years (2017–2019). Results We included 14 867 patients (82.3%; mean age 59.7 ± 10.3 years; 58.7% female). Most patients were not seen by cardiology (n = 13 072; 72.3%). After adjusting for age, sex, CVD, hypertension, diabetes and obesity, patients seen by cardiology were more likely to have any lipid‐lowering medication (OR = 1.46, 95% CI: 1.29–1.65), high‐intensity statin (OR = 1.81, 95% CI: 1.61–2.03), or proprotein convertase subtilisin‐kexin type 9 (PCSK9) inhibitor (OR = 5.96, 95% CI: 3.34–10.65) compared to those not seen by cardiology. Mean recent LDL‐c was lower in patients seen by cardiology (126.8 ± 51.6 mg/dl vs. 152.4 ± 50.2 mg/dl, respectively; p < .001). Conclusion In our predominantly rural population, a visit with cardiology improved the likelihood to be prescribed any statin, a high‐intensity statin, or PCSK9 inhibitor. This more appropriately addressed their high life‐time risk of ASCVD. Access to specialty care could improve SH patient's outcomes.
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Affiliation(s)
- Nicole A Groth
- Essentia Institute of Rural Health, Duluth, Minnesota, USA
| | - Neil J Stone
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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20
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Samuel R, Birdsey G, Amerena J. Prevalence of Familial Hypercholesterolaemia in Acute Coronary Syndrome Patients in a Large Regional Coronary Care Unit. Heart Lung Circ 2020; 30:730-733. [PMID: 33132051 DOI: 10.1016/j.hlc.2020.09.929] [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: 02/24/2019] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is an under recognised cause of coronary artery disease, despite the proven reductions in risk with early detection and treatment. METHODS Data from 180 consecutive patients presenting to a large regional hospital with acute coronary syndrome were collected. Potential FH was assessed using the Dutch Lipid Clinic Network Criteria (DLCNC), and if patients were on statins, pre-treatment cholesterol was estimated according to a validated algorithm. RESULTS Ninety per cent (90%) of patients presented with non-ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI). A total of 11 patients (6%) were classified as having phenotypic FH. The phenotypic FH cohort was younger (mean age 53.1 vs 62.0, p=0.011); and more likely to have documented ischaemic heart disease (63.6% vs 20.7%, p=0.001). PHENOTYPIC FH PATIENTS Familial hypercholesterolaemia patients had a higher rate of ezetimibe use (18.2% vs 2.4%, p=0.005), but fibrate use was not significantly different. Phenotypic FH patients also had higher levels of total cholesterol, corrected LDL and triglycerides, but no statistically significant difference in HDL levels compared with non-FH counterparts. CONCLUSIONS The prevalence of FH is relatively high among patients presenting with acute coronary syndromes. This has now been established in a regional Australian population, with similar prevalence to large European registries. This highlights the need for improved access to specialised services in regional and rural areas to reduce adverse cardiovascular (CV) outcomes.
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Affiliation(s)
- Rohit Samuel
- Department of Cardiology, Barwon Heath, Geelong, Vic, Australia.
| | - Garth Birdsey
- Department of Cardiology, Barwon Heath, Geelong, Vic, Australia; Faculty of Health, Deakin University, Melbourne, Vic, Australia
| | - John Amerena
- Department of Cardiology, Barwon Heath, Geelong, Vic, Australia; Faculty of Health, Deakin University, Melbourne, Vic, Australia
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21
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Gull R, Rashid MH, Aleem MS, Salman MO, Khalid A. A Case of Premature Triple Vessel Coronary Artery Disease and Valvular Degeneration: A Rare Presentation of Familial Hypercholesterolemia. Cureus 2020; 12:e11037. [PMID: 33214964 PMCID: PMC7673273 DOI: 10.7759/cureus.11037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Familial hypercholesterolemia (FH) is one of the inherited causes of coronary artery disease (CAD) and causes calcific valvular degeneration in rare cases. A 13-year-old boy with multiple xanthomas presented with severe chest pain, shortness of breath, and sweating. He was diagnosed with premature CAD leading to non-ST-elevation myocardial infarction, secondary to early-onset FH [severely raised low-density lipoprotein (LDL) and triglycerides (TG) on lipid profile]. CT angiogram showed triple vessel disease, and echocardiogram revealed tight aortic stenosis. Percutaneous coronary angioplasty was done, and valvuloplasty was planned on the follow-up assessment. Early diagnosis and prompt management could have prevented these complications.
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Affiliation(s)
- Rukham Gull
- Internal Medicine, Nishtar Medical University, Multan, PAK.,Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Muhammad Humayoun Rashid
- Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK.,Internal Medicine, Nishtar Medical University, Multan, PAK
| | | | | | - Ammar Khalid
- Medicine, Qamar Hospital Bagh AJK, Bagh AJK, PAK
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22
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Zayed MG, Bain SC. A man with nodules on the backs of his hands. Diabet Med 2020; 37:1766-1767. [PMID: 32039493 DOI: 10.1111/dme.14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M G Zayed
- Swansea University Medical School, Swansea, UK
| | - S C Bain
- Swansea University Medical School, Swansea, UK
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
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23
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Aggressive Treatment for Severe Forms of Familial Hypercholesterolemia. J Am Coll Cardiol 2020; 75:575-577. [PMID: 32057370 DOI: 10.1016/j.jacc.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022]
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24
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Khoury M, McCrindle BW. The Rationale, Indications, Safety, and Use of Statins in the Pediatric Population. Can J Cardiol 2020; 36:1372-1383. [PMID: 32735868 DOI: 10.1016/j.cjca.2020.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022] Open
Abstract
Together with heart-healthy lifestyle habits, statins serve as the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular disease in adults. Several conditions, most notably familial hypercholesterolemia (FH), cause early dyslipidemia and vascular disease, contributing to the development and progression of atherosclerosis from childhood and increased cardiovascular risk. In recent decades, studies increasingly have evaluated the safety and efficacy of statins in such high-risk youth. The strongest evidence for pediatric statin use is for the heterozygous FH population, whereby statin use has been shown to lower low-density lipoprotein cholesterol effectively, slow the progression of atherosclerosis and vascular dysfunction, and significantly reduce cardiovascular risk in early adulthood. Numerous meta-analyses and Cochrane reviews have demonstrated that attributed adverse effects, including liver toxicity, myositis, and rhabdomyolysis, occur no more frequently in youth receiving statins than placebos, with no impact on growth or development. However, further studies evaluating the long-term safety of pediatric statin use are required. In the current review, we summarize the pediatric experience of statin use to date, focusing on its utility for FH, Kawasaki disease, post-heart transplantation, and other at-risk populations. Current guidelines and indications for use are summarized, and the short- and medium-term safety experience is reviewed. Finally, a clinical approach to the indications, initiation, and monitoring of statins in youth is provided.
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Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Brian W McCrindle
- Labatt Family Heart Center, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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25
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Khoury M, Kavey REW, St Pierre J, McCrindle BW. Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology. Can J Cardiol 2020; 36:1417-1428. [PMID: 32679170 PMCID: PMC7358764 DOI: 10.1016/j.cjca.2020.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Rae-Ellen W. Kavey
- Preventive Cardiology–Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie St Pierre
- Department of Pediatrics, McGill University, Clinique 180, Montréal, Québec, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Udhaya Kumar S, Thirumal Kumar D, Bithia R, Sankar S, Magesh R, Sidenna M, George Priya Doss C, Zayed H. Analysis of Differentially Expressed Genes and Molecular Pathways in Familial Hypercholesterolemia Involved in Atherosclerosis: A Systematic and Bioinformatics Approach. Front Genet 2020; 11:734. [PMID: 32760426 PMCID: PMC7373787 DOI: 10.3389/fgene.2020.00734] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Background and Aims: Familial hypercholesterolemia (FH) is one of the major risk factor for the progression of atherosclerosis and coronary artery disease. This study focused on identifying the dysregulated molecular pathways and core genes that are differentially regulated in FH and to identify the possible genetic factors and potential underlying mechanisms that increase the risk to atherosclerosis in patients with FH. Methods: The Affymetrix microarray dataset (GSE13985) from the GEO database and the GEO2R statistical tool were used to identify the differentially expressed genes (DEGs) from the white blood cells (WBCs) of five heterozygous FH patients and five healthy controls. The interaction between the DEGs was identified by applying the STRING tool and visualized using Cytoscape software. MCODE was used to determine the gene cluster in the interactive networks. The identified DEGs were subjected to the DAVID v6.8 webserver and ClueGo/CluePedia for functional annotation, such as gene ontology (GO) and enriched molecular pathway analysis of DEGs. Results: We investigated the top 250 significant DEGs (p-value < 0.05; fold two change ≥ 1 or ≤ -1). The GO analysis of DEGs with significant differences revealed that they are involved in critical biological processes and molecular pathways, such as myeloid cell differentiation, peptidyl-lysine modification, signaling pathway of MyD88-dependent Toll-like receptor, and cell-cell adhesion. The analysis of enriched KEGG pathways revealed the association of the DEGs in ubiquitin-mediated proteolysis and cardiac muscle contraction. The genes involved in the molecular pathways were shown to be differentially regulated by either activating or inhibiting the genes that are essential for the canonical signaling pathways. Our study identified seven core genes (UQCR11, UBE2N, ADD1, TLN1, IRAK3, LY96, and MAP3K1) that are strongly linked to FH and lead to a higher risk of atherosclerosis. Conclusion: We identified seven core genes that represent potential molecular biomarkers for the diagnosis of atherosclerosis and might serve as a platform for developing therapeutics against both FH and atherosclerosis. However, functional studies are further needed to validate their role in the pathogenesis of FH and atherosclerosis.
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Affiliation(s)
- S. Udhaya Kumar
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - D. Thirumal Kumar
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - R. Bithia
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Srivarshini Sankar
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - R. Magesh
- Department of Biotechnology, College of Biomedical Sciences Technology and Research, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
| | - Mariem Sidenna
- Department of Biomedical Sciences, College of Health and Sciences, Qatar University, QU Health, Doha, Qatar
| | - C. George Priya Doss
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health and Sciences, Qatar University, QU Health, Doha, Qatar
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27
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Rader DJ, Sheth S. Polygenic Risk Scores in Familial Hypercholesterolemia. J Am Coll Cardiol 2020; 74:523-525. [PMID: 31345426 DOI: 10.1016/j.jacc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Daniel J Rader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Samip Sheth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Stone NJ, Grundy SM. The 2018 AHA/ACC/Multi-Society Cholesterol guidelines: Looking at past, present and future. Prog Cardiovasc Dis 2019; 62:375-383. [PMID: 31733217 DOI: 10.1016/j.pcad.2019.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023]
Abstract
The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program's Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understanding the benefits of improved lifestyle and nutrition to improve lipid profiles, major risk factors and reduce ASCVD risk. Moreover, they now provide qualitative and quantitative assessment tools to guide appropriate risk reduction LDL-C lowering therapy. Use of the Pooled Cohort Equations to determine Low, Borderline, Intermediate and High 10-year ASCVD risk is now joined by recognition of conditions and biomarkers that enhance ASCVD risk. This personalizes the risk discussion for the patient. An important addition is the selective use of coronary artery calcium (CAC) scoring to reclassify risk in patients at borderline or intermediate risk, but for whom a risk decision regarding statin therapy is uncertain. In secondary prevention, current guidelines provide criteria for determining a "very high" risk group in whom risk is especially high and in whom aggressive LDL-C lowering can be shown to provide increased absolute benefit. Current guidelines provide a comprehensive look at children and adolescents, young adults, elderly, women and issues specific to women through the life course. They provide guidance for those adults at risk due to severe hypercholesterolemia, persistent hypertriglyceridemia after secondary causes have been addressed, those with inflammatory disorders and HIV, those adults with chronic kidney disease, and those affected by issues of race/ethnicity. They conclude with a brief summary of recommendations emphasizing important concepts for providing safety with LDL-C lowering therapy. This combination of best external evidence and clinical expertise from the expert panel should provide a solid foundation for lipid management of patients at risk for or with clinical ASCVD.
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Affiliation(s)
- Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Scott M Grundy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, United States of America
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29
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Longitudinal low density lipoprotein cholesterol goal achievement and cardiovascular outcomes among adult patients with familial hypercholesterolemia: The CASCADE FH registry. Atherosclerosis 2019; 289:85-93. [DOI: 10.1016/j.atherosclerosis.2019.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/31/2019] [Accepted: 08/16/2019] [Indexed: 02/02/2023]
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30
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Hoogendoorn A, den Hoedt S, Hartman EMJ, Krabbendam-Peters I, Te Lintel Hekkert M, van der Zee L, van Gaalen K, Witberg KT, Dorst K, Ligthart JMR, Drouet L, Van der Heiden K, van Lennep JR, van der Steen AFW, Duncker DJ, Mulder MT, Wentzel JJ. Variation in Coronary Atherosclerosis Severity Related to a Distinct LDL (Low-Density Lipoprotein) Profile: Findings From a Familial Hypercholesterolemia Pig Model. Arterioscler Thromb Vasc Biol 2019; 39:2338-2352. [PMID: 31554418 PMCID: PMC6818985 DOI: 10.1161/atvbaha.119.313246] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In an adult porcine model of familial hypercholesterolemia (FH), coronary plaque development was characterized. To elucidate the underlying mechanisms of the observed inter-individual variation in disease severity, detailed lipoprotein profiles were determined. Approach and Results: FH pigs (3 years old, homozygous LDLR R84C mutation) received an atherogenic diet for 12 months. Coronary atherosclerosis development was monitored using serial invasive imaging and histology. A pronounced difference was observed between mildly diseased pigs which exclusively developed early lesions (maximal plaque burden, 25% [23%-34%]; n=5) and advanced-diseased pigs (n=5) which developed human-like, lumen intruding plaques (maximal plaque burden, 69% [57%-77%]) with large necrotic cores, intraplaque hemorrhage, and calcifications. Advanced-diseased pigs and mildly diseased pigs displayed no differences in conventional risk factors. Additional plasma lipoprotein profiling by size-exclusion chromatography revealed 2 different LDL (low-density lipoprotein) subtypes: regular and larger LDL. Cholesterol, sphingosine-1-phosphate, ceramide, and sphingomyelin levels were determined in these LDL-subfractions using standard laboratory techniques and high-pressure liquid chromatography mass-spectrometry analyses, respectively. At 3 months of diet, regular LDL of advanced-diseased pigs contained relatively more cholesterol (LDL-C; regular/larger LDL-C ratio 1.7 [1.3-1.9] versus 0.8 [0.6-0.9]; P=0.008) than mildly diseased pigs, while larger LDL contained more sphingosine-1-phosphate, ceramides, and sphingomyelins. Larger and regular LDL was also found in plasma of 3 patients with homozygous FH with varying LDL-C ratios. CONCLUSIONS In our adult FH pig model, inter-individual differences in atherosclerotic disease severity were directly related to the distribution of cholesterol and sphingolipids over a distinct LDL profile with regular and larger LDL shortly after the diet start. A similar LDL profile was detected in patients with homozygous FH.
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Affiliation(s)
- Ayla Hoogendoorn
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
| | - Sandra den Hoedt
- Department of Internal Medicine, Laboratory of Vascular Medicine, Division of Pharmacology, Vascular & Metabolic Disease (S.d.H., L.v.d.Z., K.D., J.R.v.L., M.T.M.), Erasmus MC, Rotterdam, the Netherlands
| | - Eline M J Hartman
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Experimental Cardiology (I.K.-P., M.t.L.H., D.J.D.), Erasmus MC, Rotterdam, the Netherlands
| | - Maaike Te Lintel Hekkert
- Department of Cardiology, Experimental Cardiology (I.K.-P., M.t.L.H., D.J.D.), Erasmus MC, Rotterdam, the Netherlands
| | - Leonie van der Zee
- Department of Internal Medicine, Laboratory of Vascular Medicine, Division of Pharmacology, Vascular & Metabolic Disease (S.d.H., L.v.d.Z., K.D., J.R.v.L., M.T.M.), Erasmus MC, Rotterdam, the Netherlands
| | - Kim van Gaalen
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
| | - Karen Th Witberg
- Department of Cardiology, Interventional Cardiology (K.T.W., J.M.R.L.), Erasmus MC, Rotterdam, the Netherlands
| | - Kristien Dorst
- Department of Internal Medicine, Laboratory of Vascular Medicine, Division of Pharmacology, Vascular & Metabolic Disease (S.d.H., L.v.d.Z., K.D., J.R.v.L., M.T.M.), Erasmus MC, Rotterdam, the Netherlands
| | - Jurgen M R Ligthart
- Department of Cardiology, Interventional Cardiology (K.T.W., J.M.R.L.), Erasmus MC, Rotterdam, the Netherlands
| | - Ludovic Drouet
- Department of Angiohematology, Hospital Lariboisiere, Paris, France (L.D.)
| | - Kim Van der Heiden
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
| | - Jeanine Roeters van Lennep
- Department of Internal Medicine, Laboratory of Vascular Medicine, Division of Pharmacology, Vascular & Metabolic Disease (S.d.H., L.v.d.Z., K.D., J.R.v.L., M.T.M.), Erasmus MC, Rotterdam, the Netherlands
| | - Antonius F W van der Steen
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
| | - Dirk J Duncker
- Department of Cardiology, Experimental Cardiology (I.K.-P., M.t.L.H., D.J.D.), Erasmus MC, Rotterdam, the Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, Laboratory of Vascular Medicine, Division of Pharmacology, Vascular & Metabolic Disease (S.d.H., L.v.d.Z., K.D., J.R.v.L., M.T.M.), Erasmus MC, Rotterdam, the Netherlands
| | - Jolanda J Wentzel
- From the Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (A.H., E.M.J.H., K.v.G., K.V.d.H., A.F.W.v.d.S., J.J.W.)
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31
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Vani A, Underberg JA. Lowering LDL-Cholesterol and CV Benefits: Is There a Limit to How Low LDL-C Needs to be for Optimal Health Benefits? Clin Pharmacol Ther 2019; 104:290-296. [PMID: 29882959 DOI: 10.1002/cpt.1133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the number one cause of morbidity and mortality worldwide. Low-density lipoprotein cholesterol (LDL-C) has been implicated as one of the major risk factors causing ASCVD based on multiple hierarchical levels of evidence. The advent of powerful LDL-C lowering therapies, such as the proprotein convertase subtilisin/kexin type 9 inhibitor, have raised the question of how low to target LDL-C and whether there are any adverse safety events associated with a very low LDL-C level. The present review summarizes the available evidence and concludes that even a very low LDL-C is associated with cardiovascular benefit, although the magnitude of benefit depends on baseline ASCVD risk and the absolute change in LDL-C with pharmacologic therapy. The safety data in patients treated for very low LDL-C is reassuring, although it is inconsistent and requires longer term follow-up.
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Affiliation(s)
- Anish Vani
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - James A Underberg
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
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32
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Sturm AC, Knowles JW, Gidding SS, Ahmad ZS, Ahmed CD, Ballantyne CM, Baum SJ, Bourbon M, Carrié A, Cuchel M, de Ferranti SD, Defesche JC, Freiberger T, Hershberger RE, Hovingh GK, Karayan L, Kastelein JJP, Kindt I, Lane SR, Leigh SE, Linton MF, Mata P, Neal WA, Nordestgaard BG, Santos RD, Harada-Shiba M, Sijbrands EJ, Stitziel NO, Yamashita S, Wilemon KA, Ledbetter DH, Rader DJ. Clinical Genetic Testing for Familial Hypercholesterolemia: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 72:662-680. [PMID: 30071997 DOI: 10.1016/j.jacc.2018.05.044] [Citation(s) in RCA: 340] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 01/01/2023]
Abstract
Although awareness of familial hypercholesterolemia (FH) is increasing, this common, potentially fatal, treatable condition remains underdiagnosed. Despite FH being a genetic disorder, genetic testing is rarely used. The Familial Hypercholesterolemia Foundation convened an international expert panel to assess the utility of FH genetic testing. The rationale includes the following: 1) facilitation of definitive diagnosis; 2) pathogenic variants indicate higher cardiovascular risk, which indicates the potential need for more aggressive lipid lowering; 3) increase in initiation of and adherence to therapy; and 4) cascade testing of at-risk relatives. The Expert Consensus Panel recommends that FH genetic testing become the standard of care for patients with definite or probable FH, as well as for their at-risk relatives. Testing should include the genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9); other genes may also need to be considered for analysis based on patient phenotype. Expected outcomes include greater diagnoses, more effective cascade testing, initiation of therapies at earlier ages, and more accurate risk stratification.
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Affiliation(s)
- Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania.
| | - Joshua W Knowles
- Department of Medicine, Division of Cardiovascular Medicine, and Cardiovascular Institute, Stanford University, Stanford California; The Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Samuel S Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, Delaware
| | - Zahid S Ahmad
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Seth J Baum
- The Familial Hypercholesterolemia Foundation, Pasadena, California; Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Mafalda Bourbon
- Unidade I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; University of Lisboa, Faculty of Sciences, BioISI-Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - Alain Carrié
- Sorbonne Université and Centre de Génétique Moléculaire et Chromosomique, unité de Génétique de l'Obésitéet des dyslipidémies, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joep C Defesche
- Department of Clinical Genetics, Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands
| | - Tomas Freiberger
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic; Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Ray E Hershberger
- Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Lala Karayan
- The Familial Hypercholesterolemia Foundation, Pasadena, California
| | | | - Iris Kindt
- The Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Stacey R Lane
- The Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Sarah E Leigh
- Bioinformatics, Genomics England, Queen Mary University of London, London, United Kingdom
| | - MacRae F Linton
- Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - William A Neal
- The Familial Hypercholesterolemia Foundation, Pasadena, California; Department of Pediatrics (Cardiology), West Virginia University, Morgantown, West Virginia
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor) University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Eric J Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nathan O Stitziel
- Department of Medicine, Division of Cardiology, Department of Genetics, McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Shizuya Yamashita
- Department of Cardiovascular Medicine, Rinku General Medical Center, Osaka, Japan; Departments of Community Medicine and Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Daniel J Rader
- The Familial Hypercholesterolemia Foundation, Pasadena, California; Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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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.
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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
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Al-Kindi SG, DeCicco A, Longenecker CT, Dalton J, Simon DI, Zidar DA. Rate of Statin Prescription in Younger Patients With Severe Dyslipidemia. JAMA Cardiol 2019; 2:451-452. [PMID: 28052161 DOI: 10.1001/jamacardio.2016.5162] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sadeer G Al-Kindi
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anthony DeCicco
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Chris T Longenecker
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jarrod Dalton
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | - Daniel I Simon
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David A Zidar
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Todate Y, Uwano I, Yashiro S, Chida A, Hasegawa Y, Oda T, Nagasawa K, Honma H, Sasaki M, Ishigaki Y. High Prevalence of Cerebral Small Vessel Disease on 7T Magnetic Resonance Imaging in Familial Hypercholesterolemia. J Atheroscler Thromb 2019; 26:1045-1053. [PMID: 30880296 PMCID: PMC6927808 DOI: 10.5551/jat.48553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aim: It remains unclear whether elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for cerebral vascular disease. Familial hypercholesterolemia (FH) is the most appropriate model for understanding the effects of excess LDL-C because affected individuals have inherently high levels of circulating LDL-C. To clarify the effects of hypercholesterolemia on cerebral small vessel disease (SVD), we investigated cerebrovascular damage in detail due to elevated LDL-C using high resolution brain magnetic resonance imaging (MRI) in patients with FH. Methods: Twenty-eight patients with FH and 35 healthy controls underwent 7T brain MRI. The prevalence of SVD and arterial structural changes were determined in each group. Results: The prevalence of periventricular hyperintensity (PVH) was significantly higher (control, 0% vs. FH, 14.2%, p = 0.021) and deep white matter intensity tended to be more frequent in FH patients than in controls. The prevalence of SVD in patients with forms of cerebral damage, such as lacunar infarction, PVH, deep white matter hyperintensities (DWMH), microbleeding, and brain atrophy, was significantly higher among FH patients (control, n = 2, 5.7% vs. FH, n = 7, 25.0%, p < 0.001, chi-square test). The tortuosity of major intracranial arteries and the signal intensity of lenticulostriate arteries were similar in the two groups. In FH patients, as the grade of PVH progressed, several atherosclerosis risk factors, such as body mass index, blood pressure, and triglyceride level, showed ever worsening values. Conclusion: These results obtained from FH patients revealed that persistently elevated LDL-C leads to cerebral PVH. It is necessary in the management of FH to pay attention not only to the development of coronary heart disease but also to the presence of cerebral SVD.
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Affiliation(s)
- Yusuke Todate
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Ikuko Uwano
- Division of Ultra-high Field MRI, Institute for Biomedical Sciences, Iwate Medical University
| | - Satoshi Yashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Ai Chida
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Yutaka Hasegawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Tomoyasu Oda
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Kan Nagasawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Hiroyuki Honma
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Makoto Sasaki
- Division of Ultra-high Field MRI, Institute for Biomedical Sciences, Iwate Medical University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
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Arnous MM, Alghamdi AM, Ghoraba MA. Assessment of family physicians' awareness and knowledge of familial hypercholesterolemia in governmental hospitals in Riyadh, Saudi Arabia. J Family Med Prim Care 2019; 8:1981-1986. [PMID: 31334166 PMCID: PMC6618226 DOI: 10.4103/jfmpc.jfmpc_285_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Familial Hypercholesterolemia (FH) is an inherited and complex multifactorial disease that can lead to early onset of coronary artery disease (CAD). Diagnosis, treatment, and management of FH require a well-trained physician with high awareness of the disease and different risk factors to avoid complications. Materials and Methods This cross-sectional study evaluated family physicians' awareness and knowledge of FH using self-administered questionnaires in governmental hospitals in Riyadh, Saudi Arabia, during 2018. Results A total of 225 family physicians completed the questionnaire, with a response rate of 58.4%. The mean age of respondents was 31.3 years and more than 59.1% were men. Although 72.4% of physicians rated their familiarity with FH as average and above, 48.4% of all participants had poor FH knowledge, while only 51.6% had acceptable FH knowledge. About 65.8% of physicians reported that they routinely take a detailed family history, perform a physical examination, and screen close relatives. Awareness of various clinical algorithms for diagnosis of patients with FH was very low at 52.0%. The mean FH knowledge and familiarity scores were significantly higher (P < 0.001) among participants who were older, had higher training levels, or longer years in practice. Conclusions The current study revealed significant deficits in FH familiarity, awareness, knowledge, and practice among Saudi physicians. FH educational programs directed at all physicians involved in FH patients' management are necessary to improve physicians' knowledge of all aspects of FH management, including the importance of a mechanism for identifying people at risk for a genetic condition by a process of systematic family tracing.
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Affiliation(s)
| | | | - Medhat A Ghoraba
- Department of Family Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
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Humphries SE, Cooper JA, Capps N, Durrington PN, Jones B, McDowell IFW, Soran H, Neil AHW. Coronary heart disease mortality in severe vs. non-severe familial hypercholesterolaemia in the Simon Broome Register. Atherosclerosis 2018; 281:207-212. [PMID: 30458964 PMCID: PMC6403443 DOI: 10.1016/j.atherosclerosis.2018.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/15/2018] [Accepted: 11/08/2018] [Indexed: 11/05/2022]
Abstract
Background and aims The International Atherosclerosis Society (IAS) has proposed that patients with “severe” FH (SFH) would warrant early and more aggressive cholesterol-lowering treatment such as with PCSK9 inhibitors. SFH is diagnosed if LDL-cholesterol (LDLC) > 10 mmol/L, or LDLC >8.0 mmol/L plus one high-risk feature, or LDLC >5 mmol/L plus two high-risk features. Here we compare CHD mortality in SFH and non-SFH (NSFH) patients in the UK prospective Simon Broome Register since 1991, when statin use became routine. Methods 2929 definite or possible PFH patients (51% women) aged 20–79 years were recruited from 21 UK lipid clinics and followed prospectively between 1992 and 2016. The excess CHD standardised mortality ratio (SMR) compared to the England and Wales population was calculated (with 95% confidence intervals). Results 1982 (67.7%) patients met the SFH definition. Compared to the non-SFH, significantly (p < 0.001) more SFH patients had diagnosed CHD at baseline (24.6% vs. 17.5%), were current smokers (21.9% vs 10.2%) and had a BMI > 30 kg/m2 (14.9% vs. 7.8%). The SMR for CHD mortality was significantly (p = 0.007) higher for SFH (220 (184–261) (34,134 person years, 129 deaths observed, vs. 59 expected) compared to NSFH of 144 (98–203) (15,432 person years, 32 observed vs. 22 expected). After adjustment for traditional risk factors, the Hazard Ratio for CHD mortality in SFH vs. NSFH was 1.22 (0.80–1.87) p = 0.36, indicating that the excess risk was largely accounted for by these factors. Conclusions CHD mortality remains elevated in treated FH, especially for SFH, emphasising the importance of optimal lipid-lowering and management of other risk factors. Patients with IAS-defined “severe” FH (SFH) are at highest risk of future CHD. In the UK Simon Broome FH Register ∼70% meet the SFH criteria. Those with SFH have 64% higher CHD mortality than non SFH patients. This is explained by their higher classical risk factors including untreated LDL-C.
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Affiliation(s)
- Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, WC1E 6JJ, UK.
| | - Jackie A Cooper
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, WC1E 6JJ, UK
| | - Nigel Capps
- Department of Clinical Biochemistry, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, UK
| | - Paul N Durrington
- Cardiovascular Research Group, School of Clinical and Laboratory Sciences, University of Manchester, Manchester, UK
| | - Ben Jones
- Section of Investigative Medicine, Imperial College London, London, UK
| | - Ian F W McDowell
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - Handrean Soran
- University Department of Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Reeskamp LF, Kastelein JJP, Moriarty PM, Duell PB, Catapano AL, Santos RD, Ballantyne CM. Safety and efficacy of mipomersen in patients with heterozygous familial hypercholesterolemia. Atherosclerosis 2018; 280:109-117. [PMID: 30500603 DOI: 10.1016/j.atherosclerosis.2018.11.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Heterozygous familial hypercholesterolemia (HeFH) is a common genetic disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) and increased cardiovascular disease risk. Despite multiple LDL-C-lowering therapies, many HeFH patients do not reach LDL-C targets. Mipomersen, an antisense oligonucleotide against apolipoprotein B (apoB), might further lower LDL-C in HeFH patients. We assessed the efficacy and safety of two mipomersen dosing regimens in HeFH patients and explored whether thrice-weekly dosing improves the benefit-risk profile. METHODS In this double-blind trial, HeFH patients (LDL-C >160 mg/dL) on maximal tolerated LDL-lowering therapy were randomized to mipomersen 200 mg once weekly (n = 104), mipomersen 70 mg thrice weekly (n = 102), or placebo in matching frequency (n = 103) for 60 weeks. Main outcomes were LDL-C, apoB, and lipoprotein(a) levels after 60 weeks of treatment. RESULTS Mipomersen 200 mg once weekly and mipomersen 70 mg thrice weekly significantly lowered LDL-C compared with placebo by 21.0% and 18.8%, respectively, and apoB by 22.1% and 21.7% (all p < 0.001). Lipoprotein(a) was significantly lowered by 27.7% (p < 0.001) with thrice-weekly dosing. Injection-site reactions and flu-like symptoms led to discontinuation in 21.2% (200 mg), 17.6% (70 mg), and 5.8% (placebo) of participants. Alanine transaminase was elevated (≥3× upper limit of normal at least once) in 21.2%, 21.6%, and 1.0% of subjects, respectively. CONCLUSIONS Mipomersen 200 mg once weekly and 70 mg thrice weekly are effective in lowering apoB-containing lipoproteins in HeFH patients. This is counterbalanced by limited tolerability and increased hepatic transaminase levels in about 21% of patients. The thrice-weekly dosing regimen was associated with lower frequency of flu-like symptoms, which might help avert discontinuation in some patients, but otherwise had no major benefits.
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Affiliation(s)
- Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M Moriarty
- Division of Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - P Barton Duell
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alberico L Catapano
- Dipartimento Dieccellenza Scienze Farmacologiche e Biomolecolari, Milano, Italy; IRCCS Multimedica, Milano, Italy
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Christie M Ballantyne
- Sections of Cardiology and Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
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Familial hypercholesterolaemia patient support groups and advocacy: A multinational perspective. Atherosclerosis 2018; 277:377-382. [DOI: 10.1016/j.atherosclerosis.2018.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022]
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40
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Brunham LR, Ruel I, Khoury E, Hegele RA, Couture P, Bergeron J, Baass A, Dufour R, Francis GA, Cermakova L, Mancini GJ, Brophy JM, Brisson D, Gaudet D, Genest J. Familial hypercholesterolemia in Canada: Initial results from the FH Canada national registry. Atherosclerosis 2018; 277:419-424. [DOI: 10.1016/j.atherosclerosis.2018.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/25/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022]
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Thompson GR. Atherosclerosis in cholesterol-fed rabbits and in homozygous and heterozygous LDL receptor-deficient humans. Atherosclerosis 2018; 276:148-154. [DOI: 10.1016/j.atherosclerosis.2018.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/10/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
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Ungar L, Sanders D, Becerra B, Barseghian A. Percutaneous Coronary Intervention in Familial Hypercholesterolemia Is Understudied. Front Cardiovasc Med 2018; 5:116. [PMID: 30214904 PMCID: PMC6125301 DOI: 10.3389/fcvm.2018.00116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a common heritable condition in which mutations of genes governing cholesterol metabolism result in elevated LDL levels and accelerated atherosclerosis. The treatment of FH focuses on lipid lowering drugs to decrease patients' cholesterol levels and reduce their risk of cardiovascular events. Even with optimal medical therapy, some FH patients will develop coronary atherosclerosis, suffer myocardial infarction, and require revascularization. Yet, the revascularization of FH patients has not been widely studied. Here we review FH, identify unanswered questions in the interventional management of FH patients, and explore barriers and opportunities for answering these questions. Further research is needed in this neglected but important topic in interventional cardiology.
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Affiliation(s)
- Leo Ungar
- Department of Cardiology, University of California, Irvine, Irvine, CA, United States
| | - David Sanders
- Department of Internal Medicine, University of California, Irvine, Irvine, CA, United States
| | - Brian Becerra
- Department of Internal Medicine, University of California, Irvine, Irvine, CA, United States
| | - Ailin Barseghian
- Department of Cardiology, University of California, Irvine, Irvine, CA, United States
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Wurtmann E, Steinberger J, Veach PM, Khan M, Zierhut H. Risk Communication in Families of Children with Familial Hypercholesterolemia: Identifying Motivators and Barriers to Cascade Screening to Improve Diagnosis at a Single Medical Center. J Genet Couns 2018; 28:10.1007/s10897-018-0290-0. [PMID: 30109451 DOI: 10.1007/s10897-018-0290-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
Familial hypercholesterolemia (FH) is severely underdiagnosed in the USA; yet, factors influencing family notification about risk for FH in the US pediatric setting have not been well elucidated. Most previous research on these factors has occurred in adult patient populations in European countries with organized cascade screening programs; therefore, we sought to characterize parent experiences with cascade screening in the US pediatric setting. A quantitative survey measuring family notification of FH risk information was administered to 38 parents of children with FH identified within a pediatric cardiology clinic. Participants were also asked if family notification was impacted by intrapersonal, interpersonal, institutional, community, and public policy factors identified previously in other populations. Notification of at least one of the proband's living grandparents or aunts/uncles was reported by 76% (n = 25/33) and 71% (n = 24/34) of participants, respectively. The most common reason for notification was to protect relatives from heart disease. Two of the most common reasons participants did not notify relatives were a lack of information about FH and concern that the relative would have difficulty understanding the information. Yet, only a minority of participants (39%) accessed institutional resources such as educational materials to share with relatives or assistance drafting a family letter that could address these barriers. Based on the identified barriers and motivators for family communication, we suggest facilitators to improve implementation of cascade screening.
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Affiliation(s)
- Elisabeth Wurtmann
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Julia Steinberger
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Pat McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Mindi Khan
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA.
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Fay KE, Farina LA, Burks HR, Wild RA, Stone NJ. Lipids and Women's Health: Recent Updates and Implications for Practice. J Womens Health (Larchmt) 2018; 28:752-760. [PMID: 30004840 DOI: 10.1089/jwh.2017.6745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The obstetrician/gynecologist frequently serves as the primary care physician for women. Specialty-specific guidelines vary in screening recommendations for lipid disorders; women's health practitioners often follow recommendations to screen at age 45 in the absence of other risk factors. However, 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend screening at age 21 to capture those at risk of cardiovascular disease and allow for early intervention with lifestyle and, in the most severe cases, evidence-based statins. We discuss the care of women who primarily benefit from screening: those with familial hypercholesterolemia (FH), those with the metabolic syndrome (MetS) or polycystic ovary syndrome, and those with hypertriglyceridemia. Those with FH have elevated low-density lipoprotein cholesterol from birth and a propensity for premature coronary heart disease. Early recognition of FH can allow risk-reducing interventions, as well as identification of additional affected relatives. Early detection of metabolic variables, such as in the MetS and hypertriglyceridemia, can lead to an enhanced focus on physical activity and heart-healthy diet. Finally, we discuss a practical approach to lipid management and review concerns regarding drug safety. Our objective is to provide a current overview of cardiovascular risk factor optimization that women's health practitioners can use in identifying and/or treating patients at risk for cardiovascular disease and diabetes.
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Affiliation(s)
- Kathryn E Fay
- 1 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren A Farina
- 2 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Heather R Burks
- 3 Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Robert A Wild
- 3 Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Neil J Stone
- 2 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Universal screening of children for familial hypercholesterolaemia: Value for money? Atherosclerosis 2018; 275:384-386. [PMID: 29961599 DOI: 10.1016/j.atherosclerosis.2018.06.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 11/21/2022]
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Humphries SE, Cooper JA, Seed M, Capps N, Durrington PN, Jones B, McDowell IFW, Soran H, Neil HAW. Coronary heart disease mortality in treated familial hypercholesterolaemia: Update of the UK Simon Broome FH register. Atherosclerosis 2018; 274:41-46. [PMID: 29751283 PMCID: PMC6013645 DOI: 10.1016/j.atherosclerosis.2018.04.040] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Patients with familial hypercholesterolaemia (FH) have an elevated risk of coronary heart disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992, before lipid-lowering therapy with statins was used routinely, and in the periods 1992-2008 and 2008-2016. METHODS 1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20-79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2016 for 67,060 person-years. The CHD standardised mortality ratio (SMR) compared to the population in England and Wales was calculated (with 95% Confidence intervals). RESULTS There were 585 deaths, including 252 from CHD. Overall, the observed 2.4-fold excess coronary mortality for treated DFH post-1991 was significantly higher than the 1.78 excess for PFH (35% 95% CI 3%-76%). In patients with DFH and established coronary disease, there was a significant excess coronary mortality in all time periods, but in men it was reduced from a 4.83-fold excess (2.32-8.89) pre-1992 to 4.66 (3.46-6.14) in 1992-2008 and 2.51 (1.01-5.17) post-2008, while in women the corresponding values were 7.23 (2.65-15.73), 4.42 (2.70-6.82) and 6.34 (2.06-14.81). Primary prevention in men with DFH resulted in a progressive reduction in coronary mortality over the three time-periods, with no excess mortality evident post-2008 (0.89 (0.29-2.08)), although in women the excess persisted (post-2008 3.65 (1.75-6.72)). CONCLUSIONS The results confirm the benefit of statin treatment in reducing CHD mortality, but suggest that FH patients with pre-existing CHD and women with FH may not be treated adequately.
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Affiliation(s)
- S E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, WC1E 6JJ, UK.
| | - J A Cooper
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, WC1E 6JJ, UK
| | - M Seed
- Department of Cardiology, Imperial College Faculty of Medicine, Charing Cross Campus, University of London, UK
| | - N Capps
- Department of Clinical Biochemistry, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, UK
| | - P N Durrington
- Cardiovascular Research Group, School of Clinical and Laboratory Sciences, University of Manchester, UK
| | - B Jones
- Section of Investigative Medicine, Imperial College London, UK
| | - I F W McDowell
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - H Soran
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - H A W Neil
- Wolfson College, University of Oxford, UK
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McKay AJ, Hogan H, Humphries SE, Marks D, Ray KK, Miners A. Universal screening at age 1-2 years as an adjunct to cascade testing for familial hypercholesterolaemia in the UK: A cost-utility analysis. Atherosclerosis 2018; 275:434-443. [PMID: 29937236 DOI: 10.1016/j.atherosclerosis.2018.05.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolaemia (FH) is widely underdiagnosed. Cascade testing (CT) of relatives has been shown to be feasible, acceptable and cost-effective in the UK, but requires a supply of index cases. Feasibility of universal screening (US) at age 1-2 years was recently demonstrated. We examined whether this would be a cost-effective adjunct to CT in the UK, given the current and plausible future undiagnosed FH prevalence. METHODS Seven cholesterol and/or mutation-based US ± reverse cascade testing (RCT) alternatives were compared with no US in an incremental analysis with a healthcare perspective. A decision model was used to estimate costs and outcomes for cohorts exposed to the US component of each strategy. RCT case ascertainment was modelled using recent UK CT data, and probabilistic Markov models estimated lifetime costs and health outcomes for the cohorts screened under each alternative. 1000 Monte Carlo simulations were run for each model, and average outcomes reported. Further uncertainty was explored deterministically. Threshold analysis investigated the association between undiagnosed FH prevalence and cost-effectiveness. RESULTS A strategy involving cholesterol screening followed by diagnostic genetic testing and RCT was the most cost-effective modelled (incremental cost-effectiveness ratio (ICER) versus no US £12,480/quality adjusted life year (QALY); probability of cost-effectiveness 96·8% at £20,000/QALY threshold). Cost-effectiveness was robust to both deterministic sensitivity analyses and threshold analyses that modelled ongoing case ascertainment at theoretical maximum levels. CONCLUSIONS These findings support implementation of universal cholesterol screening followed by diagnostic genetic testing and RCT for FH, under a UK conventional willingness-to-pay threshold.
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Affiliation(s)
- Ailsa J McKay
- London School of Hygiene and Tropical Medicine, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve E Humphries
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Kerr M, Pears R, Miedzybrodzka Z, Haralambos K, Cather M, Watson M, Humphries SE. Cost effectiveness of cascade testing for familial hypercholesterolaemia, based on data from familial hypercholesterolaemia services in the UK. Eur Heart J 2018; 38:1832-1839. [PMID: 28387827 PMCID: PMC5837803 DOI: 10.1093/eurheartj/ehx111] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/28/2017] [Indexed: 01/14/2023] Open
Abstract
Aims Familial hypercholesterolaemia (FH) is a vastly under-diagnosed genetic disorder, associated with early development of coronary heart disease and premature mortality which can be substantially reduced by effective treatment. Patents have recently expired on high-intensity statins, reducing FH treatment costs. We build a model using UK data to estimate the cost effectiveness of DNA testing of relatives of those with monogenic FH. Methods and Results A Markov model was used to estimate the cost effectiveness of cascade testing, using data from UK cascade services. The estimated incremental cost effectiveness ratio (ICER) was £5806 and the net marginal lifetime cost per relative tested was £2781. More than 80% of lifetime costs were diagnosis-related and incurred in the 1st year. In UK services, 23% of 6396 index cases were mutation-positive. For each mutation-positive index case, 1.33 relatives were tested, resulting overall in a rate of 0.31 tested relatives per tested index case. If the number of relatives tested per tested index case rose to 3.2 (projected by National Institute for Health and Care Excellence in 2008) the ICER would reduce to £2280 and lifetime costs to £1092. Conclusion Cascade testing of relatives of those with suspected FH is highly cost effective. The current Europe-wide high levels of undiagnosed FH, and associated morbidity and mortality, mean adoption of cascade services should yield substantial quality of life and survival gains.
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Affiliation(s)
- Marion Kerr
- Economics Department, Insight Health Economics Ltd., 16 Cambrian Road, Richmond, Surrey TW10 6JQ, UK
| | - Robert Pears
- Public Health Department, Hampshire County Council, Elizabeth II Court South, Winchester SO23 8UJ, UK
| | - Zofia Miedzybrodzka
- Department of Medical Genetics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Kate Haralambos
- Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
| | - Moyra Cather
- Northern Ireland Regional Genetics Centre, Regional Genetics Laboratories, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK
| | - Melanie Watson
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, UK
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, 5 University Street, London WC1E 6JJ, UK
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50
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Mundal LJ, Igland J, Veierød MB, Holven KB, Ose L, Selmer RM, Wisloff T, Kristiansen IS, Tell GS, Leren TP, Retterstøl K. Impact of age on excess risk of coronary heart disease in patients with familial hypercholesterolaemia. Heart 2018; 104:1600-1607. [PMID: 29622598 PMCID: PMC6161660 DOI: 10.1136/heartjnl-2017-312706] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/29/2022] Open
Abstract
Objective The primary objective was to study the risk of acute myocardial infarction (AMI) and coronary heart disease (CHD) in patients with familial hypercholesterolaemia (FH) and compare with the risk in the general population. Methods Patients with an FH mutation but without prior AMI (n=3071) and without prior CHD (n=2795) were included in the study sample during 2001–2009. We obtained data on all AMI and CHD hospitalisations in Norway. We defined incident cases as first time hospitalisation or out-of-hospital death due to AMI or CHD. We estimated standardised incidence ratios (SIRs) with 95% CIs with indirect standardisation using incidence rates for the total Norwegian population stratified by sex, calendar year and 1 year age groups as reference rates. Results SIRs for AMI (95% CIs) were highest in the age group 25–39 years; 7.5 (3.7 to 14.9) in men and 13.6 (5.1 to 36.2) in women and decreased with age to 0.9 (0.4 to 2.1) in men and 1.8 (0.9 to 3.7) in women aged 70–79 years. Similarly, SIRs for CHD were highest among patients 25–39 years old; 11.1 (7.1–17.5) in men and 17.3 (9.6–31.2) in women and decreased 2.4 (1.4–4.2) in men and 3.2 (1.5–7.2) in women at age 70–79. For all age groups, combined SIRs for CHD were 4.2 (3.6–5.0) in men and 4.7 (3.9–5.7) in women. Conclusion Patients with FH are at severely increased risk of AMI and CHD compared with the general population. The highest excess risk was in the youngest group aged 25–39 years, in both sexes.
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Affiliation(s)
- Liv J Mundal
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Lipid Clinic, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kirsten Bjørklund Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,National Advisory Unit for Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Leiv Ose
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Lipid Clinic, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Randi Marie Selmer
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Torbjorn Wisloff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Grethe S Tell
- Department of Health Registries, Norwegian Institute of Public Health, Oslo, Norway
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Lipid Clinic, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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