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Tamehri Zadeh SS, Chan DC, Mata P, Watts GF. Coronary artery event-free or resilient familial hypercholesterolemia: what's in a name? Curr Opin Endocrinol Diabetes Obes 2024:01266029-990000000-00099. [PMID: 38966915 DOI: 10.1097/med.0000000000000874] [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: 07/06/2024]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia (FH) is an autosomal semi-dominant condition, characterized by excessive circulating low-density lipoprotein cholesterol (LDL-C) from birth that substantially accelerates the onset and progression of atherosclerotic cardiovascular disease (ASCVD), classically coronary artery disease (CAD). Elevated plasma LDL-C integrated over time is unequivocally the major determinant of ASCVD in heterozygous FH (HeFH); however, the wide variation in incidence and progression of ASCVD suggests a role for a wide spectrum of risk modifiers. We reviewed recent evidence describing the features of an ASCVD-free entity referred to as resilient FH among patients with HeFH. RECENT FINDINGS Compared with nonresilient FH patients, resilient patients are more likely to be female, and have a lower prevalence of ASCVD comorbidities, higher levels of HDL-C and larger HDL particles, as well as a lower level of lipoprotein(a). A lower SAFEHEART risk score is also an independent predictor of resilient FH. Gene expression studies also demonstrate that resilient FH patients are associated with a less atherogenic gene expression profile in relation to HDL metabolism and immune responses, as reflected by higher expression of ABCA1 and ABCG1, and lower expression of STAT2 and STAT3, respectively. SUMMARY A group of HeFH patients, referred as resilient FH, can survive to advance ages without experiencing any ASCVD events. Several key contributors to the event-fee CAD in HeFH patients have been identified. This could not only improve risk stratification and management for FH but also be of major importance for the general population in primary and secondary prevention. However, resilient FH remains an under-investigated area and requires further research.
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Affiliation(s)
| | - Dick C Chan
- Medical School, University of Western Australia, Perth, Australia
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Gerald F Watts
- Medical School, University of Western Australia, Perth, Australia
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiometabolic Clinic, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia
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Lin TK, Dispenza TC. Cholesterol Screening in Children: Is a Universal Approach Working? Curr Atheroscler Rep 2023; 25:579-590. [PMID: 37594601 DOI: 10.1007/s11883-023-01129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW Ample evidence supports that an individual's lifetime risk of atherosclerotic cardiovascular disease correlates to long-term, cumulative exposure to circulating cholesterol levels, beginning in childhood. Selective screening strategies based on family history fail to identify many children with hypercholesterolemia. Universal cholesterol screening in childhood is a worthwhile goal. However, cholesterol screening rates through childhood remain low. RECENT FINDINGS Mounting evidence clarifies the barriers to cholesterol screening in children. Specific strategies to foster universal screening in childhood have been proposed. SUMMARY We present an overview of the present state of childhood cholesterol screening, summarizing historical and contemporary guidelines and collating evidence of low adherence to current guidelines. We contend that novel approaches to universal cholesterol screening in childhood are warranted, and we present potential opportunities for improvement. We call for new and universal pediatric cholesterol screening guidelines.
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Affiliation(s)
- Tracie K Lin
- Penn State Health Children's Hospital, Division of Pediatric Cardiology, 600 University Drive, Hershey, PA, 17033, USA
| | - Thomas C Dispenza
- Penn State Health Children's Hospital, Division of Pediatric Cardiology, 600 University Drive, Hershey, PA, 17033, USA.
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Johansen AK, Bogsrud MP, Christensen JJ, Rundblad A, Narverud I, Ulven S, Langslet G, Retterstøl K, Holven KB. Young women with familial hypercholesterolemia have higher LDL-cholesterol burden than men: Novel data using repeated measurements during 12-years follow-up. ATHEROSCLEROSIS PLUS 2023; 51:28-34. [PMID: 36911286 PMCID: PMC9995918 DOI: 10.1016/j.athplu.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 03/06/2023]
Abstract
Background and aims The concentration and the duration of exposure to low-density lipoprotein cholesterol (LDL-C) (LDL-C burden) is an important determinant of risk for cardiovascular disease and thresholds has recently been estimated. Individuals with familial hypercholesterolemia (FH) have increased risk of premature cardiovascular disease. The overall aim of the present study was to describe differences in LDL-C level and LDL-C burden in females and males with FH visiting an outpatient lipid clinic from a young age, using multiple LDL-C measurements during a follow-up time of 12 years. First, we aimed to study if the LDL-C concentration and the LDL-C burden is different between females and males at ages 0-10, 10-20, 20-30 and >30 years. Second, we aimed to estimate the subject-specific LDL-C burden at age 19 and 30 years, and the proportion of female and male patients that reach suggested LDL-C thresholds indicating high risk of ASCVD. Methods Data was retrospectively collected from medical records of 438 subjects (207 girls and 231 boys) with FH, referred to the Lipid Clinic, Oslo University Hospital below the age of 19 years. The LDL-C burden was estimated based on repeated LDL-C measurements over time. Results Subjects were followed over a period of mean 12.0 (SD 7.0) years, with median 10 years (7-17; 25-75 percentiles, minimum 2), with median 6 (4-9; 25-75 percentiles, minimum 2) available LDL-C measurements, starting at mean age 11 (SD 3.9) years. There was a difference in both LDL-C and LDL-C burden between sexes at different ages. On average, males had lower LDL-C over time, although this difference was less pronounced with age and males also had lower estimated LDL-C burden over time, and this difference was further exacerbated with age. Conclusion Our study shows that young women with FH have a higher LDL-C burden than their male counterparts, potentially explaining the increased excess CVD risk seen among these. It underscores the importance of careful-follow up and early treatment initiation both prior to and after pregnancies in order to limit statin-free periods.
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Affiliation(s)
- Anja K Johansen
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Amanda Rundblad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ingunn Narverud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stine Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Bjørnøy Urke E, Igland J, Mundal LJ, Holven KB, Retterstøl K, Svendsen K. Individuals with familial hypercholesterolemia have excess risk of eating disorders: a prospectively matched cohort study. Eur J Prev Cardiol 2023; 30:e13-e15. [PMID: 36508605 DOI: 10.1093/eurjpc/zwac291] [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] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Eli Bjørnøy Urke
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, P.O. Box 7804N-5020 Bergen, Norway
- Faculty of Social Sciences, Department of Health and Social Sciences, Institute of Health and Caring Science, Western Norway University of Applied Sciences, Fosswinckels gate 65007 Bergen, Norway
| | - Liv J Mundal
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo universitetssykehus, Aker, Lipidklinikken Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway
- National Advisory Unit on FH, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo universitetssykehus, Aker, NKT for FH, Postboks 4950, Nydalen 0424, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo universitetssykehus, Aker, Lipidklinikken Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Karianne Svendsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo universitetssykehus, Aker, Lipidklinikken Postboks 4959 Nydalen, 0424 Oslo, Norway
- Cancer Registry of Norway, Oslo University Hospital, P.O. Box 5313 Majorstuen, NO-0304 Oslo, Norway
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Page C, Zheng H, Wang H, Rai TS, O'Kane M, Hart P, McKee S, Watterson S. A comparison of the Netherlands, Norway and UK familial hypercholesterolemia screening programmes with implications for target setting and the UK's NHS long term plan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001795. [PMID: 37097994 PMCID: PMC10128934 DOI: 10.1371/journal.pgph.0001795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
We sought to determine the most efficacious and cost-effective strategy to follow when developing a national screening programme by comparing and contrasting the national screening programmes of Norway, the Netherlands and the UK. Comparing the detection rates and screening profiles between the Netherlands, Norway, the UK and constituent nations (England, Northern Ireland, Scotland and Wales) it is clear that maximising the number of relatives screened per index case leads to identification of the greatest proportion of an FH population. The UK has stated targets to detect 25% of the population of England with FH across the 5 years to 2024 with the NHS Long Term Plan. However, this is grossly unrealistic and, based on pre-pandemic rates, will only be reached in the year 2096. We also modelled the efficacy and cost-effectiveness of two screening strategies: 1) Universal screening of 1-2-year-olds, 2) electronic healthcare record screening, in both cases coupled to reverse cascade screening. We found that index case detection from electronic healthcare records was 56% more efficacious than universal screening and, depending on the cascade screening rate of success, 36%-43% more cost-effective per FH case detected. The UK is currently trialling universal screening of 1-2-year-olds to contribute to national FH detection targets. Our modelling suggests that this is not the most efficacious or cost-effective strategy to follow. For countries looking to develop national FH programmes, screening of electronic healthcare records, coupled to successful cascade screening to blood relatives is likely to be a preferable strategy to follow.
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Affiliation(s)
- Christopher Page
- Personalised Medicine Centre, School of Biomedical Science, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Derry, Northern Ireland, United Kingdom
| | - Huiru Zheng
- School of Computing, Ulster University, Belfast, Northern Ireland, United Kingdom
| | - Haiying Wang
- School of Computing, Ulster University, Belfast, Northern Ireland, United Kingdom
| | - Taranjit Singh Rai
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry, Northern Ireland, United Kingdom
| | - Maurice O'Kane
- Western Health and Social Care Trust, Altnagelvin Area Hospital, Derry, Northern Ireland, United Kingdom
| | - Pádraig Hart
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom
| | - Shane McKee
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom
| | - Steven Watterson
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry, Northern Ireland, United Kingdom
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6
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Hovland A, Mundal LJ, Veierød MB, Holven KB, Bogsrud MP, Tell GS, Leren TP, Retterstøl K. The risk of various types of cardiovascular diseases in mutation positive familial hypercholesterolemia; a review. Front Genet 2022; 13:1072108. [PMID: 36561318 PMCID: PMC9763610 DOI: 10.3389/fgene.2022.1072108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common, inherited disease characterized by high levels of low-density lipoprotein Cholesterol (LDL-C) from birth. Any diseases associated with increased LDL-C levels including atherosclerotic cardiovascular diseases (ASCVDs) would be expected to be overrepresented among FH patients. There are several clinical scoring systems aiming to diagnose FH, however; most individuals who meet the clinical criteria for a FH diagnosis do not have a mutation causing FH. In this review, we aim to summarize the literature on the risk for the various forms of ASCVD in subjects with a proven FH-mutation (FH+). We searched for studies on FH+ and cardiovascular diseases and also included our and other groups published papers on FH + on a wide range of cardiovascular and other diseases of the heart and vessels. FH + patients are at a markedly increased risk of a broad range of ASCVD. Acute myocardial infarction (AMI) is the most common in absolute numbers, but also aortic valve stenosis is by far associated with the highest excess risk. Per thousand patients, we observed 3.6 incident AMI per year compared to 1.9 incident aortic valve stenosis, however, standardized incidence ratio (SIR) for incident AMI was 2.3 compared to 7.9 for incident aortic valve stenosis. Further, occurrence of ischemic stroke seems not to be associated with increased risk in FH+. Clinicians should be aware of the excess risk of almost all kind of ASCVD in FH+, and the neutral risk of stroke need to be studied further in FH + patients.
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Affiliation(s)
| | - Liv J. Mundal
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Kirsten B. Holven
- Department of Nutrition, University of Oslo, Oslo, Norway,National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Martin Prøven Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Division of Mental, Bergen, Norway
| | - Trond P. Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway,Department of Nutrition, University of Oslo, Oslo, Norway,*Correspondence: Kjetil Retterstøl,
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7
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Difficulties in gauging atherosclerotic cardiovascular disease risk heterogeneity in familial hypercholesterolemia. Atherosclerosis 2022; 358:57-59. [DOI: 10.1016/j.atherosclerosis.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
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Kovács B, Cseprekál O, Diószegi Á, Lengyel S, Maroda L, Paragh G, Harangi M, Páll D. The Importance of Arterial Stiffness Assessment in Patients with Familial Hypercholesterolemia. J Clin Med 2022; 11:2872. [PMID: 35628997 PMCID: PMC9144855 DOI: 10.3390/jcm11102872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are still the leading cause of mortality due to increased atherosclerosis worldwide. In the background of accelerated atherosclerosis, the most important risk factors include hypertension, age, male gender, hereditary predisposition, diabetes, obesity, smoking and lipid metabolism disorder. Arterial stiffness is a firmly established, independent predictor of cardiovascular risk. Patients with familial hypercholesterolemia are at very high cardiovascular risk. Non-invasive measurement of arterial stiffness is suitable for screening vascular dysfunction at subclinical stage in this severe inherited disorder. Some former studies found stiffer arteries in patients with familial hypercholesterolemia compared to healthy controls, while statin treatment has a beneficial effect on it. If conventional drug therapy fails in patients with severe familial hypercholesterolemia, PCSK9 inhibitor therapy should be administered; if these agents are not available, performing selective LDL apheresis could be considered. The impact of recent therapeutic approaches on vascular stiffness is not widely studied yet, even though the degree of accelerated athero and arteriosclerosis correlates with cardiovascular risk. The authors provide an overview of the diagnosis of familial hypercholesterolemia and the findings of studies on arterial dysfunction in patients with familial hypercholesterolemia, in addition to presenting the latest therapeutic options and their effects on arterial elasticity parameters.
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Affiliation(s)
- Beáta Kovács
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary;
| | - Ágnes Diószegi
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Szabolcs Lengyel
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - László Maroda
- Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - György Paragh
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Mariann Harangi
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Dénes Páll
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
- Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
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9
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Wei N, Hu Y, Liu G, Li S, Yuan G, Shou X, Zhang X, Shi J, Zhai H. A Bibliometric Analysis of Familial Hypercholesterolemia From 2011 to 2021. Curr Probl Cardiol 2022; 48:101151. [PMID: 35202707 DOI: 10.1016/j.cpcardiol.2022.101151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 01/08/2023]
Abstract
Familial Hypercholesterolemia (FH), an autosomal dominant genetic disease, is increasingly emerging as a global threat. To learn more about the development of FH, 1 617 papers about FH and related research were retrieved in the Web of Science Core Collection from 2011 to 2021. Then, these publications were scientometrically analyzed based on CiteSpace and VOSviewer in terms of spatiotemporal distribution, author distribution, subject categories, topic distribution, and references. The results showed that research on FH is at a stable stage. More FH research has been conducted in developed countries, implying the necessity for strengthening international cooperation and exchanges. We have obtained scholars, institutions, relevant journals, and representative literatures that play an important role in FH. The research direction of FH is on the mechanisms of FH and its complications, diagnosis, statin therapy, and new lipid-lowering drug therapy. Care is the research frontier in FH, and it is in an explosive period.
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Affiliation(s)
- Namin Wei
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoxiu Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Siyu Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Guozhen Yuan
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xintian Shou
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuesong Zhang
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingjing Shi
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqiang Zhai
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.
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10
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Rocha VZ, Santos RD. Past, Present, and Future of Familial Hypercholesterolemia Management. Methodist Debakey Cardiovasc J 2021; 17:28-35. [PMID: 34824679 PMCID: PMC8588698 DOI: 10.14797/mdcvj.887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a monogenic form of severe hypercholesterolemia that, if left untreated, is associated with early onset of atherosclerosis. FH derives from genetic variants that lead to inefficient hepatic clearance of low-density lipoprotein (LDL) particles from the circulation. The FH phenotype is encountered in approximately 1 of every 300 people. The risk of atherosclerotic cardiovascular disease (ASCVD) is higher in those with FH than in normolipidemic individuals and in those with polygenic hypercholesterolemia. FH is usually diagnosed by clinical scores that consider hypercholesterolemia, family history of early ASCVD and hypercholesterolemia, and cutaneous stigmata. Genetic diagnosis is important and should be offered to individuals suspected of FH. Family cascade screening is important to identify asymptomatic hypercholesterolemic individuals. Despite the high risk of ASCVD, this risk is heterogenous in heterozygous FH and depends not only on high LDL cholesterol (LDL-C) but also on other risk biomarkers. Risk can be evaluated by considering biomarkers such as male sex, late-onset therapy (> age 40), LDL-C > 310 mg/dL, low high-density lipoprotein cholesterol, elevated lipoprotein(a), obesity, diabetes, and hypertension by using specific risk equations and by detecting subclinical coronary atherosclerosis. Statins are the main therapy for FH and change the natural history of ASCVD; however, most individuals persist with elevated LDL-C. PCSK9 inhibitors provide robust and safe LDL-C lowering in FH, although elevated costs preclude their widespread use. Newer therapies such as ANGPTL3 inhibitors add intensive LDL-C lowering for refractory forms of FH. Finally, while it is possible to normalize LDL-C in people with FH, the disease unfortunately is still severely underdiagnosed and undertreated.
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Affiliation(s)
- Viviane Z Rocha
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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11
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Xie J, Yang Y, Wang L, Pan Y, Zhang R, Qu Y, Li R, Wen W, Wu Y, Li J, Ma X. Prognostic value of coronary flow velocity reserve in patients with homozygous familial hypercholesterolemia. Echocardiography 2021; 38:1489-1495. [PMID: 34448504 DOI: 10.1111/echo.15147] [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: 03/01/2021] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Coronary flow velocity reserve (CFVR) can provide useful quantitative information on the functional status of coronary artery circulation, and an impaired CFVR (< 2.0) was associated with a significant increase in the occurrence of cardiac events. Coronary artery disease (CAD) is the leading cause of death in homozygous familial hypercholesterolemia (HoFH), but the relationship between impaired CFVR and outcome in HoFH has never been discussed before METHODS: To explore the long-term prognostic value of CFVR in patients with HoFH, 39 HoFH patients with CFVR data (mean age with 16.7 years) were enrolled from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. All patients were divided into impaired CFVR (CFVR < 2.0, n = 17) and preserved CFVR (CFVR≥2.0, n = 22) group. Follow-up was performed until a major adverse cardiac event (MACE) occurred or up to June 30, 2020 RESULTS: During a median follow-up of 89 months, 16 events were registered, 12 of which were occurred in the impaired CFVR group and four occurred in the preserved CFVR group. The event-free survival rate of impaired CFVR group was significantly lower than that in the preserved CFVR group (29.4% vs 81.8%, P < .001), and CFVR < 2.0 was independently associated with prognosis before and after adjustment for related risk factors (HR 5.197, 95% CI 1.669 to 16.178, P = .004 and HR 5.488, 95% CI 1.470 to 20.496, P = .011, respectively) CONCLUSIONS: an impaired CFVR predicts a worse outcome in HoFH. CFVR shows an independent value in the prediction of long-term outcome in HoFH.
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Affiliation(s)
- Jinjie Xie
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China.,Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ya Yang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Luya Wang
- Department of Atherosclerosis, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yufan Pan
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China.,Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruiying Zhang
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China.,Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yichen Qu
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China.,Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rongjuan Li
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China
| | - Wenhui Wen
- Department of Atherosclerosis, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Wu
- Department of Atherosclerosis, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jialu Li
- Department of Atherosclerosis, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Imaging Medicine and Nuclear Medicine, Capital Medical University, Beijing, China.,Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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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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13
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Schmidt EB, Hedegaard BS, Retterstøl K. Familial hypercholesterolaemia: history, diagnosis, screening, management and challenges. Heart 2020; 106:1940-1946. [DOI: 10.1136/heartjnl-2019-316276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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14
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Edelman A, Wetzel M, Owen C, Schadt CR, Callen JP. Xanthomas heralding pediatric coronary artery disease. JAAD Case Rep 2020; 6:753-754. [PMID: 32715071 PMCID: PMC7369508 DOI: 10.1016/j.jdcr.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Gallo A, Charriere S, Vimont A, Chapman MJ, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrié A, Bruckert E, Béliard S, Angoulvant D, Beliard S, Boccara F, Bruckert E, Cariou B, Carreau V, Carrie A, Charriere S, Cottin Y, Filippo MDI, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, Giral P, Gonbert S, Hankard R, Inamo J, Kalmykova O, Krempf M, Moulin P, Paillard F, Peretti N, Perrin A, Pierre Rabes J, Sultan A, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O. SAFEHEART risk-equation and cholesterol-year-score are powerful predictors of cardiovascular events in French patients with familial hypercholesterolemia. Atherosclerosis 2020; 306:41-49. [DOI: 10.1016/j.atherosclerosis.2020.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023]
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16
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Kolovou G, Marvaki C, Makrygiannis S, Kadda O, Giannakopoulou V, Kalogeropoulos P, Anagnostopoulou K, Goumas G, Kazianis G, Limberi S, Perrea D, Kolovou V, Bilianou H. Rationale and design of the Greek registry for familial hypercholesterolemia (GRegistry-FH) of the hellenic college of treatment of atherosclerosis (HCTA). Hellenic J Cardiol 2020; 61:284-287. [DOI: 10.1016/j.hjc.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022] Open
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17
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Semenova AE, Sergienko IV, García-Giustiniani D, Monserrat L, Popova AB, Nozadze DN, Ezhov MV. Verification of Underlying Genetic Cause in a Cohort of Russian Patients with Familial Hypercholesterolemia Using Targeted Next Generation Sequencing. J Cardiovasc Dev Dis 2020; 7:jcdd7020016. [PMID: 32423031 PMCID: PMC7345545 DOI: 10.3390/jcdd7020016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023] Open
Abstract
Russian patients with familial hypercholesterolemia (FH) were screened for pathogenic mutations using targeted next generation sequencing. Genetic testing was performed in 52 probands with definite or probable FH based on the Dutch lipid clinic network criteria (DLCN score ≥6). Blood samples were studied by massive parallel sequencing (Illumina HiSeq 1500 platform) using a custom capture library related to dyslipidemia and premature atherosclerosis. Mutations considered to be responsible for monogenic FH were identified in 48% of the probands: 24 with mutations in the LDLR gene and two with a mutation in the APOB gene. There were 22 pathogenic/likely pathogenic mutations in LDLR, eight of which have not been previously described in the literature. Four patients with a clinical picture of homozygous FH had two heterozygous LDLR mutations. Although mutation-negative patients had highly elevated total cholesterol and low-density lipoprotein cholesterol levels, only half of them had a family history of hypercholesterolemia. With respect to heterozygous FH, mutation-positive patients had higher maximum total cholesterol levels (p = 0.01), more severe carotid atherosclerotic lesions, and a higher percentage of premature peripheral artery disease (p = 0.03) than mutation-negative ones. However, the number of patients who suffered from myocardial infarction was similar between the two groups.
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Affiliation(s)
- Anna E. Semenova
- National Medical Research Center of Cardiology, 121552 Moscow, Russia; (I.V.S.); (A.B.P.); (D.N.N.); (M.V.E.)
- Health in Code SL, Clinical Department, 15006 A Coruña, Spain; (D.G.-G.); (L.M.)
- Correspondence: ; Tel.: +7-926-239-4171
| | - Igor V. Sergienko
- National Medical Research Center of Cardiology, 121552 Moscow, Russia; (I.V.S.); (A.B.P.); (D.N.N.); (M.V.E.)
| | | | - Lorenzo Monserrat
- Health in Code SL, Clinical Department, 15006 A Coruña, Spain; (D.G.-G.); (L.M.)
| | - Anna B. Popova
- National Medical Research Center of Cardiology, 121552 Moscow, Russia; (I.V.S.); (A.B.P.); (D.N.N.); (M.V.E.)
| | - Diana N. Nozadze
- National Medical Research Center of Cardiology, 121552 Moscow, Russia; (I.V.S.); (A.B.P.); (D.N.N.); (M.V.E.)
| | - Marat V. Ezhov
- National Medical Research Center of Cardiology, 121552 Moscow, Russia; (I.V.S.); (A.B.P.); (D.N.N.); (M.V.E.)
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18
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Bogsrud MP, Øyri LK, Halvorsen S, Atar D, Leren TP, Holven KB. Prevalence of genetically verified familial hypercholesterolemia among young (<45 years) Norwegian patients hospitalized with acute myocardial infarction. J Clin Lipidol 2020; 14:339-345. [DOI: 10.1016/j.jacl.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 01/11/2023]
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19
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Shehab A, Bhagavathula AS. Statin Therapy and Low-Density Lipoprotein Cholesterol Reduction after Acute Coronary Syndrome: Insights from the United Arab Emirates. Heart Views 2020; 21:80-87. [PMID: 33014300 PMCID: PMC7507910 DOI: 10.4103/heartviews.heartviews_115_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Attaining guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals (<70 mg/dl or ≥ 50% reduction) with statin therapy remains suboptimal after an acute coronary syndrome (ACS). This study aimed to assess the level of lipid-lowering therapy (LLT) utilization and achievement of LDL-C targets after ACS hospitalization in the United Arab Emirates (UAE). Methods A retrospective, observational, longitudinal database analysis of Emirati patients with ACS or stable coronary heart disease was evaluated from January 2015 to June 2018. Patients were divided based on whether or not they were treated with LLT at index hospitalization with ACS. LDL-C target level achievement was assessed according to the 2013 American College of Cardiology/American Heart Association and European Society of Cardiology/European Atherosclerosis Society guidelines. Results A total of 3,066 patients (mean age 65.5 ± 14 years) met the inclusion criteria. Overall, 58.1% (n = 1782) of the patients in the cohort were on LLT during the ACS hospitalization. At discharge, the mean LDL-C level was 84.8 ± 39.0 mg/dl, and 28%, 21%, and 9% received high-, moderate-, and low-intensity statins, respectively. At 6 months (n = 2046; 66.7%), 27.7% and 16.7% achieved an LDL-C of <70 mg/dl and 70-100 mg/dl, respectively. The highest level of LDL-C reduction by 50% within 6 months was observed among patients using moderate-intensity statin (37.2%). Conclusion A large proportion of Emirati patients were not on LLT after ACS, and the rate of LDL-C target value attainment was extremely poor (27.7%). Optimal statin utilization by closely implementing the guidelines in the UAE is recommended.
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Affiliation(s)
- Abdulla Shehab
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Akshaya Srikanth Bhagavathula
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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20
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Anker MS, von Haehling S, Papp Z, Anker SD. ESC Heart Failure receives its first impact factor. Eur J Heart Fail 2019; 21:1490-e8. [PMID: 31883221 DOI: 10.1002/ejhf.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, George August University, Göttingen, Germany and German Center for Cardiovascular Medicine (DZHK), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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21
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Krogh HW, Svendsen K, Igland J, Mundal LJ, Holven KB, Bogsrud MP, Leren TP, Retterstøl K. Lower risk of smoking-related cancer in individuals with familial hypercholesterolemia compared with controls: a prospective matched cohort study. Sci Rep 2019; 9:19273. [PMID: 31848411 PMCID: PMC6917694 DOI: 10.1038/s41598-019-55682-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/08/2019] [Indexed: 01/29/2023] Open
Abstract
According to guidelines, individuals with familial hypercholesterolemia (FH) shall receive lifestyle intervention and intensive lipid-lowering treatment from early in life to reduce the risk of coronary heart disease. Our aim was to study if treatment of FH also could affect risk of lifestyle-related cancer. We presented cumulative incidence of total cancer and lifestyle-related cancer sites in individuals with genetically verified FH (n = 5531) compared with age and sex matched controls (n = 108354). Individuals with FH had 20% lower risk of smoking-related cancer compared with the control population [HR 0.80 (95% CI, 0.65–0.98)], in particular men with FH at 40–69 years at age of diagnosis with HR 0.69 (95% CI, 0.49–0.97). The FH population and controls had similar rates of total cancer [HR 0.97 (95% CI, 0.86–1.09)], cancer related to poor diet [HR 0.82 (95% CI, 0.59–1.15)], cancer related to physical inactivity [HR 0.93 (95% CI, 0.73–1.18)], alcohol-related cancer [HR 0.98 (95% CI, 0.80–1.22)] and cancer related to obesity [HR 1.03 (95% CI, 0.89–1.21)]. In summary, we found reduced risk of smoking-related cancer in individuals with FH, most likely due to a lower prevalence of smoking. Implications of these findings can be increased motivation and thus compliance to treatment of hypercholesterolemia.
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Affiliation(s)
- Henriette W Krogh
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Karianne Svendsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. .,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv J Mundal
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Martin P Bogsrud
- National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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22
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Holven KB, Ulven SM, Bogsrud MP. Editorial Comment: Hyperlipidaemia and cardiovascular disease and impact of early cholesterol accumulation. Curr Opin Lipidol 2019; 30:490-493. [PMID: 31688171 DOI: 10.1097/mol.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kirsten B Holven
- Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo
| | - Martin P Bogsrud
- Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital
- Department of Medical Genetics, Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
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23
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Miname MH, Santos RD. Reducing cardiovascular risk in patients with familial hypercholesterolemia: Risk prediction and lipid management. Prog Cardiovasc Dis 2019; 62:414-422. [PMID: 31669498 DOI: 10.1016/j.pcad.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023]
Abstract
Familial hypercholesterolemia (FH) is a frequent genetic disorder characterized by elevated low-density lipoprotein (LDL)-cholesterol (LDL-C) levels and early onset of atherosclerotic cardiovascular disease. FH is caused by mutations in genes that regulate LDL catabolism, mainly the LDL receptor (LDLR), apolipoprotein B (APOB) and gain of function of proprotein convertase subtilisin kexin type 9 (PCSK9). However, the phenotype may be encountered in individuals not carrying the latter monogenic defects, in approximately 20% of these effects of polygenes predominate, and in many individuals no molecular defects are encountered at all. These so-called FH phenocopy individuals have an elevated atherosclerotic cardiovascular disease risk in comparison with normolipidemic individuals but this risk is lower than in those with monogenic disease. Individuals with FH are exposed to elevated LDL-C levels since birth and this explains the high cardiovascular, mainly coronary heart disease, burden of these subjects. However, recent studies show that this risk is heterogenous and depends not only on high LDL-C levels but also on presence of previous cardiovascular disease, a monogenic cause, male sex, smoking, hypertension, diabetes, low HDL-cholesterol, obesity and elevated lipoprotein(a). This heterogeneity in risk can be captured by risk equations like one from the SAFEHEART cohort and by detection of subclinical coronary atherosclerosis. High dose high potency statins are the main stain for LDL-C lowering in FH, however, in most situations these medications are not powered enough to reduce cholesterol to adequate levels. Ezetimibe and PCSK9 inhibitors should also be used in order to better treat LDL-C in FH patients.
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Affiliation(s)
- Marcio H Miname
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
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24
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Zhao PJ, Ban MR, Iacocca MA, McIntyre AD, Wang J, Hegele RA. Genetic Determinants of Myocardial Infarction Risk in Familial Hypercholesterolemia. CJC Open 2019; 1:225-230. [PMID: 32159113 PMCID: PMC7063643 DOI: 10.1016/j.cjco.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/05/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an inherited condition of elevated serum low-density lipoprotein (LDL) cholesterol leading to premature coronary heart disease. We evaluated whether FH mutations are independently associated with the development of myocardial infarction (MI), after adjusting for LDL cholesterol level and clinical risk factors. METHODS In 182 unrelated patients from different families referred with clinically suspected FH, targeted next-generation DNA sequencing was performed on 73 lipid-related genes and 178 single nucleotide polymorphisms, at 300-times mean read depth, to identify monogenic mutations and high-risk single nucleotide polymorphisms. RESULTS Pathogenic FH mutations were identified in 27% of patients. Patients with mutations, compared with those without, were 12 years younger when referred to the lipid clinic (P < 0.001) and had higher baseline and post-treatment LDL cholesterol by 1.11 mmol/L (P < 0.001) and 0.62 mmol/L (P = 0.01), respectively. The hazard ratio for premature MI with respect to having an FH mutation, controlling for sex, hypertension, body mass index, diabetes, LDL cholesterol, and smoking, was 4.51 (P = 0.002). CONCLUSION FH is a genetically diverse condition. FH mutations are independently associated with higher risk of premature MI in patients referred for hypercholesterolemia. Therefore, genotyping could guide cardiovascular risk stratification in the personalized treatment of FH.
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Affiliation(s)
- Pei Jun Zhao
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew R. Ban
- Robarts Research Institute, Western University, London, Ontario, Canada
| | | | - Adam D. McIntyre
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jian Wang
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Robert A. Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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25
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Addition of marine omega-3 fatty acids to statins in familial hypercholesterolemia does not affect in vivo or in vitro endothelial function. J Clin Lipidol 2019; 13:762-770. [PMID: 31543373 DOI: 10.1016/j.jacl.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prestatin trials reported positive effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) in cardiovascular disease, whereas recent studies and meta-analyses have not reproduced these results. The effect of n-3 PUFA in patients with familial hypercholesterolemia (FH), a group with particularly high risk of cardiovascular disease, is not well established. OBJECTIVE We investigated the effect of n-3 PUFA in the early stage of atherosclerosis in FH patients by evaluating in vivo (peripheral arterial tonometry [PAT]) and in vitro (plasma asymmetric dimethylarginine and E-selectin) endothelial function. METHODS This was a double-blind, placebo-controlled cross-over study with 34 FH patients on statin treatment (mean age 46.6 years). In random order, all individuals were treated for 3 months with high-dose n-3 PUFA (2 g, ×2) and 3 months placebo (olive oil, 2 g ×2), separated by a 3-month washout period. Anthropometric data, blood samples, and PAT were collected at 4 time points. RESULTS There were no significant changes in reactive hyperemia index measured by PAT after n-3 PUFA compared with placebo, median reactive hyperemia index after n-3 PUFA was 1.98 and after placebo 1.96 (P = .51). No significant changes were detected in the soluble endothelial marker asymmetric dimethylarginine (in 2 different assays) when comparing n-3 PUFA and placebo (P = .92 and .14, respectively). Finally, the level of E-selectin did not change significantly during the trial (P = .26). CONCLUSION Addition of n-3 PUFA to standard lipid-lowering treatment in genetically verified FH patients did not affect the in vivo endothelial function or soluble endothelial markers.
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26
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Li W, Song F, Wang X, Wang D, Chen D, Yue W, Zhang H, Wang Z, Lu Z. Relationship between metabolic syndrome and its components and cardiovascular disease in middle-aged and elderly Chinese population: a national cross-sectional survey. BMJ Open 2019; 9:e027545. [PMID: 31427317 PMCID: PMC6701700 DOI: 10.1136/bmjopen-2018-027545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess the relationship between metabolic syndrome (MetS) and its components and cardiovascular disease (CVD) according to different criteria of MetS, as well as whether the estimated association between MetS and CVD was affected by different definitions of MetS among the Chinese population. DESIGN Population-based, cross-sectional study. SETTING Data were from a large-scale national stroke screening survey, China National Stroke Screening and Prevention Project. PARTICIPANTS A nationally representative sample of 109 551 Chinese adults aged ≥40 years in 2014-2015 were included. PRIMARY OUTCOME MEASURES CVD conditions (stroke, coronary heart disease (CHD) and atrial fibrillation (AF)) diagnosed by clinicians were self-reported. RESULTS ORs after adjusting for CHD, stroke, AF and CVD in those with MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion were 1.56 (95% CI 1.48 to 1.63), 1.23 (95% CI 1.17 to 1.30), 1.14 (95% CI 1.08 to 1.21) and 1.40 (95% CI 1.35 to 1.45); 1.51 (95% CI 1.44 to 1.58), 1.20 (95% CI 1.14 to 1.26), 1.09 (95% CI 1.04 to 1.15) and 1.34 (95% CI 1.29 to 1.38) with the American Heart Association/National Heart, Lung, and Blood Institute criterion; and 1.41 (95% CI 1.35 to 1.48), 1.24 (95% CI 1.19 to 1.30), 1.12 (95% CI 1.06 to 1.18) and 1.31 (95% CI 1.27 to 1.35) with the International Diabetes Federation criterion, respectively. Elevated blood pressures were all highly related to the prevalence of stroke and AF, and reduced high-density lipoprotein-cholesterol was associated with a higher OR for CHD than other individual components of MetS. CONCLUSIONS MetS is significantly associated with CVD, and the prevalence of CVD was more evident when MetS was defined according to the NCEP ATP III criterion. Developing effective public health strategies for the prevention, detection and treatment of MetS should be an urgent priority to reduce the burden of CVD in China.
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Affiliation(s)
- Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medica College, Huazhong University of Science and Technology, Wuhan, China
| | - Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Xiaojun Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medica College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medica College, Huazhong University of Science and Technology, Wuhan, China
| | - Dajie Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medica College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Yue
- Neurology Department, Tianjin Huanhu Hospital, Tianjin, China
| | - Hong Zhang
- Department of Science and Education, People's Hospital of Deyang City, Deyang, China
| | - Zhihong Wang
- Health Science Center, Shenzhen University First Affiliated Hospital, Shenzhen, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medica College, Huazhong University of Science and Technology, Wuhan, China
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Wisløff T, Mundal LJ, Retterstøl K, Igland J, Kristiansen IS. Economic evaluation of lipid lowering with PCSK9 inhibitors in patients with familial hypercholesterolemia: Methodological aspects. Atherosclerosis 2019; 287:140-146. [PMID: 31280039 DOI: 10.1016/j.atherosclerosis.2019.06.900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proved to reduce low density lipoprotein cholesterol levels in numerous clinical trials. In two large clinical trials, PCSK9 inhibitor treatment reduced the risk of cardiovascular disease. Our aim was to explore the impact of varying assumptions about clinical effectiveness on health and economic outcomes for patients with familial hypercholesterolemia. METHODS We used a previously published and validated Norwegian model for cardiovascular disease. The model was updated with recent data from the world's second largest registry of patients with genetically confirmed familial hypercholesterolemia. We performed analyses for 24 different subgroups of patients based on age, gender, statin tolerance and previous history of cardiovascular disease. RESULTS In 1 out of 24 subgroups, PCSK9 inhibitors were cost-effective when effectiveness was modelled using direct relative efficacy as reported in the FOURIER trial. When using assumptions, as suggested in a recent consensus statement from the European Atherosclerosis Society, 14 subgroups were cost-effective. CONCLUSIONS Cost-effectiveness of PCSK9 inhibitors depends highly on assumptions regarding effectiveness. Basing assumptions only on randomised controlled trials, and not taking into account varying effects based on baseline cholesterol level, results in much fewer groups being cost-effective.
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Affiliation(s)
- Torbjørn Wisløff
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.
| | - Liv J Mundal
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kjetil Retterstøl
- The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 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
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Al-Tamimi H, Al-Dawood A, Awaishesh S, Abdalla T. Resveratrol mitigates hypercholesterolemia exacerbated hyperthermia in chronically heat-stressed rats. Vet World 2019; 12:337-344. [PMID: 31040579 PMCID: PMC6460863 DOI: 10.14202/vetworld.2019.337-344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/17/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Hypercholesterolemia (HC) is the major leading cause of cardiovascular disease worldwide. Such atherogenic aberration deeply impacts blood circulation. Resveratrol (R) is a polyphenol that has received attention as a hypolipidemic, antioxidant, and vascular agility advocate. Efficient blood redistribution is a key element in mammalian thermoregulation. We hypothesized that R treatment may aid in mitigating hyperthermic responses under both acute and chronic heat stress (HS) conditions in HC male rats. MATERIALS AND METHODS All rats were initially fitted with miniaturized thermologgers to measure core body temperature (Tcore). With a 2 × 2 factorial arrangement, four groups were randomly allotted, in which half of the animals ingested an HC diet (C+), while the other half ingested a control (C-) diet, throughout the whole study duration of 35 days. Seven rats from each dietary treatment, however, received R (R+; 13 mg/kg BW/day), while the rest received normal saline (R-) for 5 continuous days. All animals were maintained at thermoneutrality (TN; ambient temperature; Ta=23.15±0.04°C) for a period of 30 continuous days (days 0-29). On day 29, an acute HS (HS; Ta=35.86±0.37°C; for 9 nocturnal h) was imposed. Then, from day 29, a chronic HS protocol (Ta=32.28±1.00°C) was maintained until the past day of the trial (day 34), after which blood samples were drawn for analyses of platelet (PL) count, total antioxidant activity (TAO), total cholesterol (TC), triglycerides (TGs), and lipid peroxidation (LP). RESULTS Switching animals from TN to HS resulted in abrupt rises in Tcore. The HC diet induced a significant (p<0.01) hyperlipidemia over the control of diet-consuming rats. Interestingly, the hyperthermic response to acute HS was highly pronounced in the rats consuming the C- diet, while the C+ diet exacerbated the chronic HS-induced hyperthermia. Despite failure to improve TAO in the C+ diet, R+ treatment caused a marked (p<0.05) decline in nighttime - hyperthermia in C+ rats, likely by enhancing blood flow to extremities (for heat dissipation) as delineated by drastic downregulations of C+ related rises in PL, TC, TG, and LP (HC diet by R+ interaction; p<0.03). CONCLUSION The hyperthermic response in C- groups was attributed to higher amount of feed intake than those consuming the C+ diet. Yet, the R+ improvement of thermoregulation in the C+ group was likely related to enhancement of vascular hemodynamics. Resveratrol intake mitigated chronic HS-evoked hyperthermia in rats. Such an approach is worthy to follow-up in other mammals and humans.
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Affiliation(s)
- Hosam Al-Tamimi
- Department of Animal Science, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Amani Al-Dawood
- Department of Applied Biology, Faculty of Sciences, Tafila Technical University, Tafila, 66110, Jordan
| | - Saddam Awaishesh
- Department of Nutrition and Food Processing, Faculty of Agriculture, Al-Balqa Applied University, Al-Salt, 19117, Jordan
| | - Tony Abdalla
- Department of Animal Science, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, 22110, Jordan
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LDL-cholesterol goal achievement, cardiovascular disease, and attributed risk of Lp(a) in a large cohort of predominantly genetically verified familial hypercholesterolemia. J Clin Lipidol 2019; 13:279-286. [DOI: 10.1016/j.jacl.2019.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 01/27/2023]
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Perez-Calahorra S, Laclaustra M, Marco-Benedí V, Lamiquiz-Moneo I, Pedro-Botet J, Plana N, Sanchez-Hernandez RM, Amor AJ, Almagro F, Fuentes F, Suarez-Tembra M, Civeira F. Effect of lipid-lowering treatment in cardiovascular disease prevalence in familial hypercholesterolemia. Atherosclerosis 2019; 284:245-252. [PMID: 30827715 DOI: 10.1016/j.atherosclerosis.2019.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The impact on heterozygous familial hypercholesterolemia (HeFH) health led by high-intensity lipid-lowering therapy (HILLT) is unknown, and the question remains if there is still an unacceptably high residual risk to justify treatment with new lipid-lowering drugs. METHODS This observational, retrospective, multicenter, national study in Spain, whose information was obtained from a national dyslipemia registry, was designed to establish the current prevalence of cardiovascular disease (CVD) in HeFH and to define the impact of HILLT on CVD in this population. Odds were estimated using several logistic regression models with progressive adjustment. RESULTS 1958 HeFH, mean age 49.3 ± 14.3 years, were included in the analysis. At inclusion in the registry, 295 patients (15.1%) had suffered CVD and 164 (55.6%) had suffered the first event before the onset lipid-lowering treatment. Exposition to treatment associated more than ten times lower odds for CVD than in subjects naïve to treatment (OR 0.085, 95% CI 0.063-0.114, p < 0.001). A first CVD event after a mean treatment period of 9.1 ± 7.2 years occurred in 131 out of 1615 (8.1%) HeFH subjects, and 115 (87.8%) of them were on HILLT. CONCLUSIONS Current prevalence of CVD among HeFH is one third of that reported before the statins era. Early initiation and prolonged lipid-lowering treatment was associated with a reduction in CVD. New cases of CVD, in spite of HILLT, appeared mostly among patients accumulating risk factors and probably they may be considered for further lipid-lowering drugs.
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Affiliation(s)
- Sofía Perez-Calahorra
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Martín Laclaustra
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Victoria Marco-Benedí
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Itziar Lamiquiz-Moneo
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Juan Pedro-Botet
- Lipid and Vascular Risk Unit, Department of Endocrinology and Nutrition, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolism, Hospital Universitari Sant Joan, Institut d'Investigación Sanitaria Pere Virgili (IISPV), CIBERDEM, Reus, Tarragona, Spain
| | - Rosa M Sanchez-Hernandez
- Lipid Unit, Endocrinology Department, Hospital Universitario Insular de Gran Canaria, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de, Gran Canaria, Spain
| | - Antonio J Amor
- Lipid Unit, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, CIBEROBN, Barcelona, Spain
| | - Fátima Almagro
- Lipid Unit, Hospital Universitario Donostia, San Sebastián, Spain
| | - Francisco Fuentes
- Lipid Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, CIBEROBN, Universidad de Córdoba, Spain
| | | | - Fernando Civeira
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain.
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Lee S, Akioyamen LE, Aljenedil S, Rivière JB, Ruel I, Genest J. Genetic testing for familial hypercholesterolemia: Impact on diagnosis, treatment and cardiovascular risk. Eur J Prev Cardiol 2019; 26:1262-1270. [DOI: 10.1177/2047487319829746] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims Familial hypercholesterolemia (FH) is the most common genetic disorder in medicine, with a prevalence of 1/250. Affected individuals have elevated low-density lipoprotein cholesterol (LDL-C) and an increased lifetime risk of atherosclerotic cardiovascular disease (ASCVD). The diagnosis of FH is based on algorithms that include LDL-C levels, physical manifestations, family history of high LDL-C and premature ASCVD, and, more recently, genetic testing. We sought to determine the impact of genetic testing on the: 1) diagnosis of ‘definite familial hypercholesterolemia’, 2) initiation and adherence of lipid-lowering therapy and 3) risk of ASCVD. Methods We performed a systematic review and meta-analysis, pooling odds ratios and 95% confidence intervals for ASCVD from studies comparing risk estimates in individuals harboring FH-causing variants and unaffected individuals. Results After screening 3304 unique publications, 56 studies were included in the analysis. 1) Genetic testing provided confirmation of FH in 28–80%, over clinical criteria alone, depending on the diagnostic algorithm and the method of analysis. In two large population-based studies comprising 76,751 individuals, an FH-causing variant was identified in only 1.7–2.5% of subjects with an LDL-C > 4.9 mmol/L (190 mg/dL). 2) A confirmed molecular diagnosis increased lipid-lowering therapy adherence (five studies, n = 4181 definite FH). 3) Loss-of-function variant of the LDLR were at a markedly increased risk of myocardial infarction (odds ratio 6.77, 95% confidence interval 4.75–9.66), and patients with a milder (hypomorphic) pathogenic LDLR change had a 4.4-fold increase in risk (odds ratio 4.4, 95% confidence interval 2.34–8.26), compared with controls. Conclusion DNA sequencing confirms the diagnosis of FH but has a poor yield in unselected patients whose sole criterion is an elevated LDL-C. Initiation and adherence to treatment is improved. The risk of ASCVD is 4.4- to 6.8-fold increased in patients with an FH-causing variant compared with controls, depending on the severity of the DNA change.
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Affiliation(s)
- Seohyuk Lee
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | | | - Sumayah Aljenedil
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Jean-Baptiste Rivière
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Isabelle Ruel
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
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Liu Y, Xia N, Hu W, Zhao W. Lipid-altering Efficacy of Ezetimibe/Simvastatin Compared with
Rosuvastatin in Hypercholesterolaemic Patients: A Meta-Analysis. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.200.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mata P, Alonso R, Pérez de Isla L. Atherosclerotic cardiovascular disease risk assessment in familial hypercholesterolemia: does one size fit all? Curr Opin Lipidol 2018; 29:445-452. [PMID: 30382952 DOI: 10.1097/mol.0000000000000553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia is a frequent genetic disease associated with lifelong elevation of LDL-cholesterol and premature atherosclerotic cardiovascular disease (ASCVD). Statins are the cornerstone of treatment. However, with the introduction of novel LDL-cholesterol-lowering therapies, it is necessary to identify familial hypercholesterolemia patients presenting a significantly high residual ASCVD risk. The aim of this review is to provide an update on the recent literature concerning cardiovascular risk stratification including the role of coronary imaging. RECENT FINDINGS Several factors have shown to be independent predictors of ASCVD in familial hypercholesterolemia. These include clinical scores with cardiovascular risk factors, coronary imaging and novel protein biomarkers. However, the recent introduction of the SAFEHEART risk-equation (SAFEHEART-RE) could allow a more accurate ASCVD risk prediction in familial hypercholesterolemia. SUMMARY This article highlights the SAFEHEART-RE as a model to predict incident ASCVD in familial hypercholesterolemia. This equation is a simple and widely applicable tool for use in every clinical setting. Furthermore, coronary atherosclerosis assessed by coronary computed-tomographic angiography (coronary-CTA) is independently associated to the cardiovascular risk estimated according to the SAFEHEART-RE. This equation, as well as coronary-CTA and new biomarkers, could increase individual ASCVD risk stratification and could improve the efficiency and the use of new lipid-lowering therapies in familial hypercholesterolemia.
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Affiliation(s)
- Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Nutrition Department, Clínica las Condes, Santiago de Chile, Chile
| | - Leopoldo Pérez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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Familial hypercholesterolemia and atherosclerotic cardiovascular mortality among Korean adults with low levels of serum cholesterol. Atherosclerosis 2018; 278:103-109. [DOI: 10.1016/j.atherosclerosis.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/22/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022]
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Mehta R, Martagon AJ, Galan Ramirez GA, Gonzalez Retana G, Martinez-Beltran M, Vargas Vazquez A, Vazquez-Cardenas A, Aguilar-Salinas CA. The development of the Mexican Familial Hypercholesterolemia (FH) National Registry. Atherosclerosis 2018; 277:517-523. [DOI: 10.1016/j.atherosclerosis.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/03/2018] [Accepted: 06/07/2018] [Indexed: 11/15/2022]
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Civeira F, Pocoví M. Familial hypercholesterolemia in pediatric patients. The success begins here. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:179-180. [PMID: 29986810 DOI: 10.1016/j.arteri.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Fernando Civeira
- Instituto De Investigación Sanitaria Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España.
| | - Miguel Pocoví
- Instituto De Investigación Sanitaria Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
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Holven KB, Narverud I, van Lennep JR, Versmissen J, Øyri LK, Galema-Boers A, Langslet G, Ulven SM, Veierød MB, Retterstøl K, Bogsrud MP. Sex differences in cholesterol levels from birth to 19 years of age may lead to increased cholesterol burden in females with FH. J Clin Lipidol 2018; 12:748-755.e2. [DOI: 10.1016/j.jacl.2018.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/08/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
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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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Treatment goal attainment in children with familial hypercholesterolemia: A cohort study of 302 children in Norway. J Clin Lipidol 2018; 12:375-382. [DOI: 10.1016/j.jacl.2017.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/15/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
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Holven KB, Ulven SM, Bogsrud MP. Hyperlipidemia and cardiovascular disease with focus on familial hypercholesterolemia. Curr Opin Lipidol 2017; 28:445-447. [PMID: 28857860 DOI: 10.1097/mol.0000000000000449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kirsten B Holven
- aNorwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity, and Preventive Medicine bDepartment of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Increased risk of heart failure and atrial fibrillation in heterozygous familial hypercholesterolemia. Atherosclerosis 2017; 266:69-73. [PMID: 28992466 DOI: 10.1016/j.atherosclerosis.2017.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/15/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) and atrial fibrillation/flutter (AF) are important causes of morbidity and mortality. Subjects with familial hypercholesterolemia (FH) carry a high risk of coronary artery disease (CAD) but it is not known if the risk of HF and AF is increased in FH. The present study investigated the incidence of hospitalization for HF and AF in a genetically verified FH cohort, age 25 years and older, compared to the general population. METHODS Incidence rates of hospitalization for HF and AF were estimated from national registry data. Standardized incidence ratios (SIRs) were calculated. RESULTS 4273 genotyped FH patients (51.7% women) with a total observation period of 18,300 patient years were studied. Overall, the expected number of FH patients with HF was 27.7 and the observed number of cases was 54 (SIR (95% CI) 2.0 (1.5-2.6)). The highest excess risk was observed in the age group 25-49 years, where SIRs were 3.8 (1.2-11.8) and 4.2 (2.0-8.8) in women and men, respectively. The total expected number of FH patients with AF was 39.4 while the observed number of cases was 77 (SIR 2.0 (1.6-2.4)). Among FH patients with an incident event of HF, nearly 90% had a previous diagnosis of CAD, and nearly 40% had suffered from a myocardial infarction. CONCLUSIONS We demonstrate a doubling of the risk of hospitalization for HF or AF in patients with FH. This is could have an important prognostic impact for patients and economic impact for the society.
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Pećin I, Hartgers ML, Hovingh GK, Dent R, Reiner Ž. Prevention of cardiovascular disease in patients with familial hypercholesterolaemia: The role of PCSK9 inhibitors. Eur J Prev Cardiol 2017. [PMID: 28644091 PMCID: PMC5574519 DOI: 10.1177/2047487317717346] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Familial hypercholesterolaemia is an autosomal dominant inherited disorder characterised by elevated low-density lipoprotein cholesterol levels and consequently an increased risk of atherosclerotic cardiovascular disease (ASCVD). Familial hypercholesterolaemia is relatively common, but is often underdiagnosed and undertreated. Cardiologists are likely to encounter many individuals with familial hypercholesterolaemia; however, patients presenting with premature ASCVD are rarely screened for familial hypercholesterolaemia and fasting lipid levels are infrequently documented. Given that individuals with familial hypercholesterolaemia and ASCVD are at a particularly high risk of subsequent cardiac events, this is a missed opportunity for preventive therapy. Furthermore, because there is a 50% chance that first-degree relatives of individuals with familial hypercholesterolaemia will also be affected by the disorder, the underdiagnosis of familial hypercholesterolaemia among patients with ASCVD is a barrier to cascade screening and the prevention of ASCVD in affected relatives. Targeted screening of patients with ASCVD is an effective strategy to identify new familial hypercholesterolaemia index cases. Statins are the standard treatment for individuals with familial hypercholesterolaemia; however, low-density lipoprotein cholesterol targets are not achieved in a large proportion of patients despite treatment. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to reduce low-density lipoprotein cholesterol levels considerably in individuals with familial hypercholesterolaemia who are concurrently receiving the maximal tolerated statin dose. The clinical benefit of PCSK9 inhibitors must, however, also be considered in terms of their cost-effectiveness. Increased awareness of familial hypercholesterolaemia is required among healthcare professionals, particularly cardiologists and primary care physicians, in order to start early preventive measures and to reduce the mortality and morbidity associated with familial hypercholesterolaemia and ASCVD.
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Affiliation(s)
- Ivan Pećin
- 1 Department of Internal Medicine, University Hospital Centre Zagreb, Croatia.,2 School of Medicine, University of Zagreb, Croatia
| | - Merel L Hartgers
- 3 Department of Vascular Medicine, Academic Medical Centre, the Netherlands
| | - G Kees Hovingh
- 3 Department of Vascular Medicine, Academic Medical Centre, the Netherlands
| | - Ricardo Dent
- 4 Amgen (Europe) GmbH, Zug, Switzerland.,5 Esperion Therapeutics Inc., Ann Arbor, USA
| | - Željko Reiner
- 1 Department of Internal Medicine, University Hospital Centre Zagreb, Croatia.,2 School of Medicine, University of Zagreb, Croatia
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Abstract
PURPOSE OF REVIEW To review how leveraging familial hypercholesterolemia registries can impact molecular genetic research and precision medicine. RECENT FINDINGS Familial hypercholesterolemia is both much more common and more phenotypically heterogeneous than previously thought with some evidence for significant genotype to phenotype correlations. Genetic testing for familial hypercholesterolemia is becoming both more widely available and cheaper, spurring conversations about its clinical utility. SUMMARY In most countries, familial hypercholesterolemia is underdiagnosed and diagnosed later in life, often after the onset of coronary heart disease (CHD). Familial hypercholesterolemia is undertreated; low goal attainment and additional modifiable risk factors further increase CHD risk. Familial hypercholesterolemia epitomizes the goal of precision medicine to define a subset of individuals with a high risk of morbidity and mortality through genetic diagnosis to manage and treat the risk accordingly. Genetic cascade screening can be used to identify familial hypercholesterolemia patients at a younger age and start timely treatment to prevent CHD. Familial hypercholesterolemia registries are tools for clinical research and improving healthcare planning and patient care. As genotype and phenotype correlations in familial hypercholesterolemia become increasingly understood, this information will likely play a more important role in diagnosis and treatment especially as the cost of genetic testing continues to decline.
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Affiliation(s)
- Iris Kindt
- aThe FH Foundation, Pasadena, California, USA bFundacion Hipercolesterolemia Familiar, Madrid, Spain cDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University, Stanford University Falk Cardiovascular Research Center, Stanford, California, USA
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46
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Ellis KL, Pang J, Watts GF. Registries, codifications and cardiovascular outcomes in familial hypercholesterolaemia. Eur J Prev Cardiol 2016; 24:133-136. [DOI: 10.1177/2047487316680696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Katrina L Ellis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Jing Pang
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Australia
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