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Selič P, Klemenc-Ketiš Z, Zelko E, Kravos A, Rifel J, Makivić I, Poplas Susič A, Tevžič Š, Cerovič M, Peterlin B, Kopčavar Guček N. Development of an Algorithm for Determining of Genetic Risk at the Primary Healthcare Level - A New Tool for Primary Prevention: A Study Protocol. Zdr Varst 2020; 59:27-32. [PMID: 32952700 PMCID: PMC7478082 DOI: 10.2478/sjph-2020-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/21/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia. METHODS A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented. RESULTS The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared. CONCLUSION By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.
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Affiliation(s)
- Polona Selič
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Erika Zelko
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Andrej Kravos
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Janez Rifel
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Irena Makivić
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
| | | | - Špela Tevžič
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
| | - Metka Cerovič
- Community Health Centre dr. Adolfa Drolca Maribor, Ulica talcev 9, 2000Maribor, Slovenia
| | - Borut Peterlin
- University Medical Centre Ljubljana, Clinical Institute of Medical Genetics, Šlajmerjeva 4, 1000Ljubljana, Slovenia
| | - Nena Kopčavar Guček
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
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Cohen N, Brzezinski RY, Ehrenwald M, Shapira I, Zeltser D, Berliner S, Shenhar-Tsarfaty S, Milwidsky A, Rogowski O. Familial history of heart disease and increased risk for elevated troponin in apparently healthy individuals. Clin Cardiol 2019; 42:760-767. [PMID: 31175686 PMCID: PMC6671830 DOI: 10.1002/clc.23214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Family history of heart disease (FH-HD) is associated with an increase drisk of subsequent HD. High sensitive cardiac troponin T (hs-cTnT) is arecognized biomarker of myocyte injury even in HD free patients. We examined the association between FH-HD and hs-cTnT in apparently healthy individuals. HYPOTHESIS FH-HD is associated with elevated hs-cTnT in apparently healthy individuals. METHODS In a cross sectional study we analyzed data of apparently healthy individuals (n=3,821) recruited for the Tel-Aviv Medical Center Inflammation Survey (TAMCIS). Blood samples were obtained for hs-cTnT and high sensitive CRP (hs-CRP) among other tests. FH-HD was defined as first degree family member with HD diagnosis and classified as premature if the diagnosis was done before the age of 55 for men or 65 for women. RESULTS Elevated hs-cTnT (>14 ng/L) was more common in FH-HD of any age, and in premature FH-HD (FH-P-HD) participants than in participants without FH-HD (4.4% vs 2.0%, p<0.001 and 4.3% vs 2.0%, p=0.001, respectively). Adjustmentfor potential risk factors with association to elevated hs-cTnT (age, sex, BMI, hypertension, diabetes, hs-CRP, smoking and physical activity), showed that FH-HD and FH-P-HD remained significantly associated with elevated hs-cTnT (OR=1.62, p=0.025 and OR=1.70, p=0.039, respectively). Furthermore, we found that a significant interaction between FH-HD or FH-P-HD and high levels ofhs-CRP (>3 mg/L) increased the risk for elevated hs-cTnT (OR=3.07, p=0.036 for FH-HD and OR=3.25, p=0.053 for FH-P-HD). CONCLUSIONS FH-HD and its interaction with elevated hs-CRP levels were significantly associated with elevated hs-cTnT in apparently healthy individuals suggesting that an inflammatory process may be involved in this association.
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Affiliation(s)
- Noa Cohen
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ehrenwald
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Shapira
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Milwidsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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