1
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Gu J, Epland M, Ma X, Park J, Sanchez RJ, Li Y. A machine-learning algorithm using claims data to identify patients with homozygous familial hypercholesterolemia. Sci Rep 2024; 14:8890. [PMID: 38632285 PMCID: PMC11024086 DOI: 10.1038/s41598-024-58719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Homozygous familial hypercholesterolemia (HoFH) is an underdiagnosed and undertreated ultra-rare disease. We utilized claims data from the Komodo Healthcare Map database to develop a machine-learning model to identify potential HoFH patients. We tokenized patients enrolled in MyRARE (patient support program for those prescribed evinacumab-dgnb in the United States) and linked them with their Komodo claims. A true positive HoFH cohort (n = 331) was formed by including patients from MyRARE and patients with prescriptions for evinacumab-dgnb or lomitapide. The negative cohort (n = 1423) comprised patients with or at risk for cardiovascular disease. We divided the cohort into an 80% training and 20% testing set. Overall, 10,616 candidate features were investigated; 87 were selected due to clinical relevance and importance on prediction performance. Different machine-learning algorithms were explored, with fast interpretable greedy-tree sums selected as the final machine-learning tool. This selection was based on its satisfactory performance and its easily interpretable nature. The model identified four useful features and yielded precision (positive predicted value) of 0.98, recall (sensitivity) of 0.88, area under the receiver operating characteristic curve of 0.98, and accuracy of 0.97. The model performed well in identifying HoFH patients in the testing set, providing a useful tool to facilitate HoFH screening and diagnosis via healthcare claims data.
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Affiliation(s)
- Jing Gu
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
| | | | | | | | - Robert J Sanchez
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA.
| | - Ying Li
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, New York, NY, 10591, USA
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2
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Arriaga-Cázares HE, Vega-Morales D, Moreno-Treviño CA, Juarez-Juarez JL, Pérez-Arizmendi CA, Martagón-Rosado AJ. Comparison of Two Strategies for Hypercholesterolemia Detection through Point-of-Care Testing. Diagnostics (Basel) 2024; 14:143. [PMID: 38248020 PMCID: PMC10814133 DOI: 10.3390/diagnostics14020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Childhood dyslipidemia is a common condition that can lead to atherosclerotic cardiovascular disease in adulthood. It is usually multifactorial. Screening for cholesterol disorders in children varies based on risk factors, with some guidelines recommending cascade screening for children with a clear family history of familial hypercholesterolemia, targeted screening for those with specific risk factors, and universal screening. Point-of-care testing (POCT) cholesterol tests offer potential advantages, including ease of use, portability, increased patient access, low cost, fewer medical or laboratory visits, and instant results. This study aimed to evaluate the effect of POCT cholesterol screening on the diagnosis of hypercholesterolemia in children in a family practice setting. METHODS We used a POCT cholesterol analyzer to perform two different (universal and targeted) screening approaches for dyslipidemia in children. We used the NCEP guidelines for the classification of the results. RESULTS We screened 183 children, 105 in the universal screening group and 78 in the targeted screening group. Eight patients in the targeted screening group had elevated cholesterol levels (p = 0.02). CONCLUSIONS All participants received instant feedback and recommendations. Using a targeted screening approach, POCT could be a practical and effective tool for identifying at-risk children with hypercholesterolemia.
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Affiliation(s)
- Héctor Eliud Arriaga-Cázares
- Instituto Mexicano del Seguro Social, Hospital de Traumatología y Ortopedia N.º 21, Monterrey 64000, Mexico
- Escuela de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
| | - David Vega-Morales
- Instituto Mexicano del Seguro Social, Hospital General de Zona 17, Monterrey 64420, Mexico;
| | - Carlos Alberto Moreno-Treviño
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Juana Lorena Juarez-Juarez
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Carlos Azael Pérez-Arizmendi
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Alexandro J. Martagón-Rosado
- Escuela de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
- Institute for Obesity Research, Instituto Tecnologico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
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Gijón-Conde T, Ferré Sánchez C, Ibáñez Delgado I, Rodríguez Jiménez B, Banegas JR. Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:1-11. [PMID: 37743130 DOI: 10.1016/j.arteri.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5μIU/mL. RESULTS 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.
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Affiliation(s)
- Teresa Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España; Unidad Docente de Medicina de Familia, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España; Asociación MAdrileña de Riesgo Enfermedad VAscular (AMAREVA), Madrid, España.
| | - Carolina Ferré Sánchez
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | - Isabel Ibáñez Delgado
- Centro de Salud Universitario Cerro del Aire, Servicio Madrileño de Salud, Majadahonda, Madrid, España
| | | | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Meng R, Wei Q, Zhou J, Zhang B, Li C, Shen M. A systematic review of cost-effectiveness analysis of different screening strategies for familial hypercholesterolemia. J Clin Lipidol 2024; 18:e21-e32. [PMID: 37980172 DOI: 10.1016/j.jacl.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
AIMS Diagnosis rate of familial hypercholesterolemia (FH) remained less than 10 % globally and the economic evaluation results of different FH screening strategies varied. This study aimed to systematically review the methodology and results of cost effectiveness analysis (CEA) of FH screening, which will provide evidence support for health-related decision-making. METHODS The Medline/PubMed, Embase, Cochrane Library, Web of science, National Health Service Economic Evaluation Database (NHSEED) and CEA Registry databases were electronically searched to collect full economic evaluation from the establishment of the databases to June 30, 2022. The quality of included studies was evaluated by the Consolidated Health Economic Evaluation Reporting Standards statement 2022 (CHEERS 2022) checklist. RESULTS Among 232 retrieved studies, 18 economic evaluations were included and all of them are from developed countries, with an average quality score of 0.73. The decision tree model and/or Markov model were constructed by thirteen articles (72 %). Twelve studies (67 %) adopted the healthcare perspective and the lifetime horizon to compare the costs and health outcome of different screening strategies. The results of eight studies indicated that cascade screening was a cost-effective strategy compared with no screening, which was more pronounced in younger adults. Universal screening in young adults aged 16 years or 18-40 years (n=3) and in children aged 1-2 years combined with reverse cascade screening (n=3) are both cost-effective. The probability of being cost-effective for cascade screening (n=6) and universal screening (n=1) of young aged 18-40 years were greater than 95 %. CONCLUSIONS Our review demonstrated the economic advantages of cascade screening, universal screening of young adults, and universal screening of newborns combined with reverse cascade screening. Further health economic evaluation is needed in children and in low- and middle-income countries.
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Affiliation(s)
- Rui Meng
- China-Australia Joint Research Center for Infectious Diseases (Drs Meng, Shen), School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Qiran Wei
- School of International Pharmaceutical Business (Drs Wei, Zhou), China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Jiting Zhou
- School of International Pharmaceutical Business (Drs Wei, Zhou), China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Baoming Zhang
- College of Stomatology (Dr Zhang), Xi'an Jiaotong University, Xi'an, Shaanxi 710004, PR China; Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research (Dr Zhang), College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, PR China; School of Public Health (Drs Zhang, Li), Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Chao Li
- School of Public Health (Drs Zhang, Li), Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases (Drs Meng, Shen), School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province (Dr Shen), Xi'an, Shaanxi 710061, PR China.
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Timoshchenko O, Ivanoshchuk D, Semaev S, Orlov P, Zorina V, Shakhtshneider E. Diagnosis of Familial Hypercholesterolemia in Children and Young Adults. Int J Mol Sci 2023; 25:314. [PMID: 38203485 PMCID: PMC10778969 DOI: 10.3390/ijms25010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
The early detection and treatment of familial hypercholesterolemia (FH) in childhood and adolescence are critical for increasing life expectancy. The purpose of our study was to investigate blood lipid parameters, features of physical signs of cholesterol accumulation, and a personal and family history of premature cardiovascular diseases in children and young adults when FH is diagnosed. The analysis included patients under 18 years of age (n = 17) and young adults (18-44 years of age; n = 43) who received a diagnosis of FH according to clinical criteria. Targeted high-throughput sequencing was performed using a custom panel of 43 genes. A family history of cardiovascular diseases was more often noted in the group under 18 years of age than in young adults (p < 0.001). Among young adults, there was a high prevalence of typical signs of the disease such as tendon xanthomas and the early development of arterial atherosclerosis (p < 0.001). By molecular genetic testing, "pathogenic" and "probably pathogenic" variants were identified in the genes of 73.3% of patients under 18 years of age and 51.4% of patients 18-44 years of age. Thus, blood lipid screening tests combined with an accurate assessment of the family history is a highly relevant and inexpensive option for diagnosing FH in childhood. Molecular genetic testing allows us to make an accurate diagnosis and to improve adherence to treatment.
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Affiliation(s)
- Olga Timoshchenko
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
| | - Dinara Ivanoshchuk
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (ICG SB RAS), 10 Prospekt Ak. Lavrentyeva, Novosibirsk 630090, Russia
| | - Sergey Semaev
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (ICG SB RAS), 10 Prospekt Ak. Lavrentyeva, Novosibirsk 630090, Russia
| | - Pavel Orlov
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (ICG SB RAS), 10 Prospekt Ak. Lavrentyeva, Novosibirsk 630090, Russia
| | - Valentina Zorina
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (ICG SB RAS), 10 Prospekt Ak. Lavrentyeva, Novosibirsk 630090, Russia
| | - Elena Shakhtshneider
- Institute of Internal and Preventive Medicine (IIPM)–Branch of ICG SB RAS, 175/1 Borisa Bogatkova Str., Novosibirsk 630089, Russia (E.S.)
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (ICG SB RAS), 10 Prospekt Ak. Lavrentyeva, Novosibirsk 630090, Russia
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de Sá ACMGN, Gomes CS, Prates EJS, Brant LCC, Malta DC. Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study. Sci Rep 2023; 13:20459. [PMID: 37993629 PMCID: PMC10665423 DOI: 10.1038/s41598-023-47692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99-3.84), poor/very poor (OR 3.02; 95% CI 1.30-7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02-0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23-0.98) and complete high school and more (OR 0.45; 95% CI 0.21-0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.
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Affiliation(s)
| | - Crizian Saar Gomes
- Postgraduate Program in Public Health, Faculty of Medicine of the Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Elton Junio Sady Prates
- Postgraduate Nursing Program, Nursing School, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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7
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Yip MK, Kwan EYW, Leung JYY, Lau EYF, Poon WT. Genetic Spectrum and Cascade Screening of Familial Hypercholesterolemia in Routine Clinical Setting in Hong Kong. Genes (Basel) 2023; 14:2071. [PMID: 38003014 PMCID: PMC10671696 DOI: 10.3390/genes14112071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a prevalent but often underdiagnosed monogenic disorder affecting lipoprotein metabolism, and genetic testing for FH has not been widely conducted in Asia in the past. In this cross-sectional study of 31 probands (19 adults and 12 children) and an addition of 15 individuals (12 adults and 3 children), who underwent genetic testing and cascade screening for FH, respectively, during the period between February 2015 and July 2023, we identified a total of 25 distinct LDLR variants in 71.0% unrelated probands. Among the adult proband cohort, a higher proportion of genetically confirmed cases exhibited a positive family history of premature cardiovascular disease. Treatment intensity required to achieve an approximate 50% reduction in pretreatment low-density lipoprotein cholesterol (LDL-C) exhibited potentially better diagnostic performance compared to pretreatment LDL-C levels, Dutch Lipid Clinic Network Diagnostic Criteria (DLCNC) score, and modified DLCNC score. Adult individuals identified through cascade screening demonstrated less severe phenotypes, and fewer of them met previously proposed local criteria for FH genetic testing compared to the probands, indicating that cascade screening played a crucial role in the early detection of new cases that might otherwise have gone undiagnosed. These findings underscore the significance of genetic testing and cascade screening in the accurate identification and management of FH cases.
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Affiliation(s)
- Man-Kwan Yip
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Elaine Yin-Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China;
| | - Jenny Yin-Yan Leung
- Department of Medicine and Geriatrics, Ruttonjee Hospital, Wan Chai, Hong Kong, China;
| | - Emmy Yuen-Fun Lau
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Wing-Tat Poon
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
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8
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Longoni M, Bhasin K, Ward A, Lee D, Nisson M, Bhatt S, Rodriguez F, Dash R. Real-world utilization of guideline-directed genetic testing in inherited cardiovascular diseases. Front Cardiovasc Med 2023; 10:1272433. [PMID: 37915745 PMCID: PMC10616303 DOI: 10.3389/fcvm.2023.1272433] [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: 08/04/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Background Cardiovascular disease continues to be the leading cause of death globally. Clinical practice guidelines aimed at improving disease management and positively impacting major cardiac adverse events recommend genetic testing for inherited cardiovascular conditions such as dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), hereditary amyloidosis, and familial hypercholesterolemia (FH); however, little is known about how consistently practitioners order genetic testing for these conditions in routine clinical practice. This study aimed to assess the adoption of guideline-directed genetic testing for patients diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH. Methods This retrospective cohort study captured real-world evidence of genetic testing from ICD-9-CM and ICD-10-CM codes, procedure codes, and structured text fields of de-identified patient records in the Veradigm Health Insights Ambulatory EHR Research Database linked with insurance claims data. Data analysis was conducted using an automated electronic health record analysis engine. Patient records in the Veradigm database were sourced from more than 250,000 clinicians serving over 170 million patients in outpatient primary care and specialty practice settings in the United States and linked insurance claims data from public and private insurance providers. The primary outcome measure was evidence of genetic testing within six months of condition diagnosis. Results Between January 1, 2017, and December 31, 2021, 224,641 patients were newly diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH and included in this study. Substantial genetic testing care gaps were identified. Only a small percentage of patients newly diagnosed with DCM (827/101,919; 0.8%), HCM (253/15,507; 1.6%), LQTS (650/56,539; 1.2%), hereditary amyloidosis (62/1,026; 6.0%), or FH (718/49,650; 1.5%) received genetic testing. Conclusions Genetic testing is underutilized across multiple inherited cardiovascular conditions. This real-world data analysis provides insights into the delivery of genomic healthcare in the United States and suggests genetic testing guidelines are rarely followed in practice.
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Affiliation(s)
- Mauro Longoni
- Global Medical Affairs Organization, Illumina, Inc., San Diego, CA, United States
| | | | | | | | | | - Sucheta Bhatt
- Global Medical Affairs Organization, Illumina, Inc., San Diego, CA, United States
| | - Fatima Rodriguez
- HealthPals Inc., Redwood, CA, United States
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Rajesh Dash
- HealthPals Inc., Redwood, CA, United States
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
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9
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Paetow U, Kordonouri O, Schwab KO. [Advantages of Universal Early Childhood Screening for Familial Hypercholesterolaemia in Germany]. KLINISCHE PADIATRIE 2023; 235:5-12. [PMID: 35240713 DOI: 10.1055/a-1721-2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Zusammenfassung
Hintergrund Kardiovaskuläre Ereignisse sind die wichtigste
Mortalitätsursache in der westlichen Welt. Die familiäre
Hypercholesterinämie (FH) zeichnet sich durch erhöhte
low-density Lipoprotein-Cholesterin- und Gesamtcholesterin-Spiegel im peripheren
Blut aus. Die FH beruht zumeist auf einer genetischen Veränderung im
LDL-Rezeptorgen und gehört zu den häufigsten monogenen
Erkrankungen. Bei der homozygoten Form ist die Mortalität aufgrund
kardiovaskulärer Ereignisse im Kindes- und Jugendalter extrem hoch. Auch
die heterozygote Form der FH führt unbehandelt früh zu
kardiovaskulären Ereignissen und sollte frühzeitig
diagnostiziert und behandelt werden, um eine Atherosklerose zu vermeiden. Die
präventive und sichere Anwendung einer medikamentösen
Lipidsenkung konnte für Kinder gezeigt werden.
Methode Literatursuche in Cochrane library, Medline, NCBI databases.
Ergebnisse Anders als in europäischen Nachbarländern wurde
in Deutschland im Kindesalter kein universelles Screening auf diese
häufige Erkrankung etabliert, obwohl dies in den Leitlinien gefordert
wird. In der vorliegenden Arbeit wird die Literatur untersucht hinsichtlich der
Kausalität der Erkrankung, der Therapie im Kindesalter sowie
hinsichtlich des Zutreffens klassischer und modifizierter Kriterien für
das Durchführen eines vorgeschlagenen universellen FH-Screenings zum 5.
Geburtstag mit anschließendem reversen Kaskadenscreening bei
Verwandten.
Schlussfolgerung Die Autoren plädieren für die
Einführung eines universellen FH-Screenings in Deutschland zur
Vorsorgeuntersuchung U9 mit 5 Jahren. Eine Analyse anhand des Goldstandards
klassischer Kriterien nach Wilson und Jungner sowie anhand im zeitlichen Kontext
angepasster Kriterien zeigt die Vorteile eines universellen
frühkindlichen FH-Screening. Dieses kann präventiv das
kardiovaskuläre Risiko absenken, das Fortschreiten der Atherosklerose
verlangsamen und zu niedrigeren Inzidenzen von Schlaganfall und Herzinfarkt im
Erwachsenenalter beitragen. Neben den diagnostizierten FH-Kindern können
auch deren betroffene Verwandte erkannt werden.
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Affiliation(s)
- Ulrich Paetow
- Pädiatrische Endokrinologie/Diabetologie und Lipidologie, Klinikum und Fachbereich Medizin Johann Wolfgang Goethe-Universität Frankfurt Zentrum für Kinder- und Jugendmedizin Klinik I, Frankfurt am Main, Germany
| | - Olga Kordonouri
- Allgemeinpädiatrie, Diabetologie/Endokrinologie, Gastroenterologie und Klinische Forschung, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Karl Otfried Schwab
- Zentrum für Kinder- und Jugendmedizin, Pädiatrische Endokrinologie, Diabetologie, Lipidologie und klinische Forschung, Universitätsklinikum Freiburg im Breisgau, Germany
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Jones LK, Walters N, Brangan A, Ahmed CD, Wilemon KA, Campbell-Salome G, Rahm AK, Gidding SS, Sturm AC. Patient Experiences Align with The Familial Hypercholesterolemia Global Call to Action. Am J Prev Cardiol 2022; 10:100344. [PMID: 35517872 PMCID: PMC9061613 DOI: 10.1016/j.ajpc.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/15/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To explore alignment of perspectives from individuals and families with familial hypercholesterolemia (FH) to the FH Global Call to Action recommendations. Methods Interviews and focus groups were conducted with individuals and families with FH from multiple U.S. health systems and the Family Heart Foundation community to capture lived experiences and to identify barriers to diagnosis, cascade testing, and treatment. Participant perspectives were examined and classified, according to their alignment to recommendations of the FH Global Call to Action. Results A total of 75 lived experiences were analyzed. Participants were majority female, mostly white, older, and well-educated. Participants most frequently mentioned recommendations were family-based care (84%) and screening, testing, & diagnosis (84%), followed by treatment (69%), advocacy (60%), cost & value (59%), awareness (56%), research & registries (43%), and severe & homozygous FH (11%). An average of 4.65 (SD 1.76) recommendations were mentioned. Conclusions The FH Global Call to Action was driven by the persistent unmet needs of those living with FH in receiving a timely diagnosis, appropriate care, and support to prevent early morbidity and mortality. Patient- and family-centric perspectives suggest the FH Global Call to Action captures these concerns. Acting on recommendations, particularly improvements in screening and family-based care, will address patient, and public health, concerns.
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Affiliation(s)
- Laney K. Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
- Heart and Vascular Institute, Geisinger, Danville, PA, United States of America
- Corresponding author.
| | - Nicole Walters
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
| | - Andrew Brangan
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
| | | | | | | | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
| | - Samuel S. Gidding
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States of America
- Heart and Vascular Institute, Geisinger, Danville, PA, United States of America
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11
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Catapano AL, Daccord M, Damato E, Humphries SE, Neely RDG, Nordestgaard BG, Pistollato M, Steinhagen-Thiessen E. How should public health recommendations address Lp(a) measurement, a causative risk factor for cardiovascular disease (CVD)? Atherosclerosis 2022; 349:136-143. [DOI: 10.1016/j.atherosclerosis.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 12/18/2022]
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12
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Silva PRDS, Jannes CE, Oliveira TG, Krieger JE, Santos RD, Pereira AC. Pharmacological treatment with lipid-lowering agents after molecular identification of familial hypercholesterolemia: results from the Hipercol Brasil cohort. J Clin Lipidol 2022; 16:198-207. [DOI: 10.1016/j.jacl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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13
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Ferrières J, Banks V, Pillas D, Giorgianni F, Gantzer L, Lekens B, Ricci L, Dova-Boivin M, Chauny JV, Villa G, Désaméricq G. Screening and treatment of familial hypercholesterolemia in a French sample of ambulatory care patients: A retrospective longitudinal cohort study. PLoS One 2021; 16:e0255345. [PMID: 34339471 PMCID: PMC8328334 DOI: 10.1371/journal.pone.0255345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIMS Untreated Familial Hypercholesterolemia (FH) leads to premature morbidity and mortality. In France, its epidemiology and management are understudied in ambulatory care. We described the clinical profile, pharmacological management, and clinical outcomes in a French sample of FH patients. METHODS This was a retrospective longitudinal study on patients from The Health Improvement Network (THIN®) database in France, between October 2016-June 2019. Patients ≥18 years, with probable/definite FH based on the Dutch Lipid Clinic Network (DLCN) criteria were included. Baseline characteristics, lipid profile, lipid-lowering therapy (LLT), low-density lipoprotein-cholesterol (LDL-C) goal achievement; and disease management at 6-month of follow-up were analyzed. RESULTS 116 patients with probable (n = 70)/definite (n = 46) FH were included (mean age:57.8±14.0 years; 56.0% women; 9.5% with personal history of cardiovascular events); 90 patients had data available at follow-up. At baseline, 77.6% of patients had LDL-C>190 mg/dL, 27.6% were not receiving LLTs, 37.9% received statins alone, 20.7% statins with other LLTs, and 7.7% other LLTs. High-intensity statins were prescribed to 11.2% of patients, 30.2% received moderate-intensity statins, and 8.6% low-intensity statins. Only 6.0% of patients achieved LDL-C goal. At 6-month of follow-up, statins discontinuation and switching were 22.7% and 2.3%, respectively. None of the patients received proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors at baseline nor follow-up. CONCLUSIONS Despite the existence of effective LLTs, FH patients are suboptimally-treated, do not achieve LDL-C goal, and exhibit worsened pharmacological management over time. Future studies with longer follow-up periods and assessment of factors affecting LDL-C management, including lifestyle and diet, are needed.
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Affiliation(s)
- Jean Ferrières
- Department of Cardiology and UMR INSERM 1295, Toulouse Rangueil University Hospital, Toulouse, France
| | | | | | | | | | | | - Lea Ricci
- Amgen (France) SAS, Boulogne-Billancourt, France
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14
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Brett T, Chan DC, Radford J, Heal C, Gill G, Hespe C, Vargas-Garcia C, Condon C, Sheil B, Li IW, Sullivan DR, Vickery AW, Pang J, Arnold-Reed DE, Watts GF. Improving detection and management of familial hypercholesterolaemia in Australian general practice. Heart 2021; 107:1213-1219. [PMID: 34016696 PMCID: PMC8292556 DOI: 10.1136/heartjnl-2020-318813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare. METHODS Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH. RESULTS A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (-16%, p<0.01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p<0.001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p<0.05). CONCLUSIONS A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting. TRIAL REGISTRATION NUMBER 12616000630415.
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Affiliation(s)
- Tom Brett
- General Practice and Primary Health Care Research Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- General Practitioner, Mosman Park Medical Centre, Perth, Western Australia, Australia
| | - Dick C Chan
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Jan Radford
- Launceston Clinical School, University of Tasmania, Launceston, Tasmania, Australia
| | - Clare Heal
- Mackay Clinical School, James Cook University, Mackay, Queensland, Australia
| | - Gerard Gill
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Charlotte Hespe
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Cristian Vargas-Garcia
- General Practice and Primary Health Care Research Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Carmen Condon
- General Practice and Primary Health Care Research Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Barbara Sheil
- General Practice and Primary Health Care Research Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ian W Li
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Alistair W Vickery
- Division of General Practice, The University of Western Australia, Perth, Western Australia, Australia
| | - Jing Pang
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Diane E Arnold-Reed
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Gerald F Watts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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15
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Jones LK, Walters N, Brangan A, Ahmed CD, Gatusky M, Campbell-Salome G, Ladd IG, Sheldon A, Gidding SS, McGowan MP, Rahm AK, Sturm AC. Acceptability, Appropriateness, and Feasibility of Automated Screening Approaches and Family Communication Methods for Identification of Familial Hypercholesterolemia: Stakeholder Engagement Results from the IMPACT-FH Study. J Pers Med 2021; 11:587. [PMID: 34205662 PMCID: PMC8234213 DOI: 10.3390/jpm11060587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022] Open
Abstract
Guided by the Conceptual Model of Implementation Research, we explored the acceptability, appropriateness, and feasibility of: (1) automated screening approaches utilizing existing health data to identify those who require subsequent diagnostic evaluation for familial hypercholesterolemia (FH) and (2) family communication methods including chatbots and direct contact to communicate information about inherited risk for FH. Focus groups were conducted with 22 individuals with FH (2 groups) and 20 clinicians (3 groups). These were recorded, transcribed, and analyzed using deductive (coded to implementation outcomes) and inductive (themes based on focus group discussions) methods. All stakeholders described these initiatives as: (1) acceptable and appropriate to identify individuals with FH and communicate risk with at-risk relatives; and (2) feasible to implement in current practice. Stakeholders cited current initiatives, outside of FH (e.g., pneumonia protocols, colon cancer and breast cancer screenings), that gave them confidence for successful implementation. Stakeholders described perceived obstacles, such as nonfamiliarity with FH, that could hinder implementation and potential solutions to improve systematic uptake of these initiatives. Automated health data screening, chatbots, and direct contact approaches may be useful for patients and clinicians to improve FH diagnosis and cascade screening.
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Affiliation(s)
- Laney K. Jones
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Nicole Walters
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Andrew Brangan
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | | | - Michael Gatusky
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
- Department of Advertising, University of Florida, Gainesville, FL 33620, USA
| | - Ilene G. Ladd
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Amanda Sheldon
- The FH Foundation, Pasadena, CA 91101, USA; (C.D.A.); (A.S.); (M.P.M.)
| | - Samuel S. Gidding
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Mary P. McGowan
- The FH Foundation, Pasadena, CA 91101, USA; (C.D.A.); (A.S.); (M.P.M.)
- Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Alanna K. Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA; (N.W.); (A.B.); (M.G.); (G.C.-S.); (I.G.L.); (S.S.G.); (A.K.R.); (A.C.S.)
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16
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Relationship beetween Primary and Hospital Care in cardiovascular prevention and treatment of dyslipidemias. Derivation algorithm. Discharge criteria. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33 Suppl 1:65-70. [PMID: 33966816 DOI: 10.1016/j.arteri.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
Effective cardiovascular prevention requires taking advantage of all opportunities for patient contact with the Health Services in order to detect risk factors (CVRF) and global cardiovascular risk stratification (CVR). This particularly involves the Primary Care (PC) services, which must be coordinated with the Hospital Care (HC) in order to make all health resources available to the population. In addition, it is necessary to take into account the contribution of Occupational Health and Pharmacy services. There are hopeful signs as regards the possibility of overcoming the barriers that limit the necessary exchange of information between PC and HC professionals, as a basis for adequate coordination between both levels of care. This includes the implementation of referral and discharge algorithms (in this review this means those related to dyslipidaemias) accepted by professionals at both levels, and currently facilitated by the availability of new corporate tools (mobile, email, virtual consultations). The challenge lies in seizing the opportunity they offer to make their implementation effective.
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17
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Improving Familial Hypercholesterolemia Index Case Detection: Sequential Active Screening from Centralized Analytical Data. J Clin Med 2021; 10:jcm10040749. [PMID: 33668494 PMCID: PMC7918446 DOI: 10.3390/jcm10040749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
The majority of familial hypercholesterolemia index cases (FH-IC) remain underdiagnosed and undertreated because there are no well-defined strategies for the universal detection of FH. The aim of this study was to evaluate the diagnostic yield of an active screening for FH-IC based on centralized analytical data. From 2016 to 2019, a clinical screening of FH was performed on 469 subjects with severe hypercholesterolemia (low-density lipoprotein cholesterol ≥220 mg/dL), applying the Dutch Lipid Clinic Network (DLCN) criteria. All patients with a DLCN ≥ 6 were genetically tested, as were 10 patients with a DLCN of 3–5 points to compare the diagnostic yield between the two groups. FH was genetically confirmed in 57 of the 84 patients with DLCN ≥ 6, with a genetic diagnosis rate of 67.9% and an overall prevalence of 12.2% (95% confidence interval: 9.3% to 15.5%). Before inclusion in the study, only 36.8% (n = 21) of the patients with the FH mutation had been clinically diagnosed with FH; after genetic screening, FH detection increased 2.3-fold (p < 0.001). The sequential, active screening strategy for FH-IC increases the diagnostic yield for FH with a rational use of the available resources, which may facilitate the implementation of FH universal and family-based cascade screening strategies.
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18
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Camacho OFC, Molina GP, Catalá CFM, Reali JR, Cruz RM, Zenteno JC. Familial Hypercholesterolemia: Update and Review. Endocr Metab Immune Disord Drug Targets 2021; 22:198-211. [PMID: 33563162 DOI: 10.2174/1871530321666210208212148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
Knowledge of epidemiology, genetic etiopathogenesis, diagnostic criteria, and management of familial hypercholesterolemia have increased in the last two decades. Several population studies have shown that familial hypercholesterolemia is more frequent than previously thought, making this entity the most common metabolic disease with monogenic inheritence in the world. Identification of causal heterozygous pathogenic variants in LDLR, APOB, and PCSK9 genes have increased diagnostic accuracy of classical criteria (extreme hypercholesterolemia, personal / family history of premature coronary artery disease or other cardiovascular disease). Genetic screening has been recently introduced in many European countries to detect patients with familial hypercholesterolemia, mainly affected pediatric subjects, asymptomatic or those at the beggining of their disease, with the purpose of increasing surveillance and avoiding complications such as cardiovascular diseases. Cholesterol-lowering drugs should be started as soon as the diagnosis is made. Various combinations between drugs can be used when the goal is not achieved. New therapies, including small interference ribonucleic acids (siRNA) are being tested in different clinical trials.
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Affiliation(s)
| | - Glustein Pozo Molina
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Claudia Fabiola Méndez Catalá
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Julia Reyes Reali
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - René Méndez Cruz
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, . Mexico
| | - Juan Carlos Zenteno
- Biochemistry Department, Faculty Medicine, National Autonomous University of Mexico, Mexico City,. Mexico
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19
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Kinnear FJ, Lithander FE, Searle A, Bayly G, Wei C, Stensel DJ, Thackray AE, Hunt L, Shield JPH. Reducing cardiovascular disease risk among families with familial hypercholesterolaemia by improving diet and physical activity: a randomised controlled feasibility trial. BMJ Open 2020; 10:e044200. [PMID: 33372081 PMCID: PMC7772289 DOI: 10.1136/bmjopen-2020-044200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Familial hypercholesterolaemia (FH) elevates low-density lipoprotein cholesterol (LDL-C) and increases cardiovascular disease (CVD) risk. This study aimed to provide evidence for the feasibility of conducting a randomised controlled trial to evaluate the efficacy of an intervention designed to improve diet and physical activity in families with FH. DESIGN A parallel, randomised, waitlist-controlled, feasibility pilot trial. SETTING Three outpatient lipid clinics in the UK. PARTICIPANTS Families that comprised children (aged 10-18 years) and their parent with genetically diagnosed FH. INTERVENTION Families were randomised to either 12-week usual care or intervention. The behavioural change intervention aimed to improve dietary, physical activity and sedentary behaviours. It was delivered to families by dietitians initially via a single face-to-face session and then by four telephone or email follow-up sessions. OUTCOME MEASURES Feasibility was assessed via measures related to recruitment, retention and intervention fidelity. Postintervention qualitative interviews were conducted to explore intervention acceptability. Behavioural (dietary intake, physical activity and sedentary time) and clinical (blood pressure, body composition and blood lipids) outcomes were collected at baseline and endpoint assessments to evaluate the intervention's potential benefit. RESULTS Twenty-one families (38% of those approached) were recruited which comprised 22 children and 17 adults with FH, and 97% of families completed the study. The intervention was implemented with high fidelity and the qualitative data revealed it was well accepted. Between-group differences at the endpoint assessment were indicative of the intervention's potential for improving diet in children and adults. Evidence for potential benefits on physical activity and sedentary behaviours was less apparent. However, the intervention was associated with improvements in several CVD risk factors including LDL-C, with a within-group mean decrease of 8% (children) and 10% (adults). CONCLUSIONS The study's recruitment, retention, acceptability and potential efficacy support the development of a definitive trial, subject to identified refinements. TRIAL REGISTRATION NUMBER ISRCTN24880714.
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Affiliation(s)
- Fiona Jane Kinnear
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Fiona E Lithander
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Graham Bayly
- Department of Clinical Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Christina Wei
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alice E Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Linda Hunt
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Julian P H Shield
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- University of Bristol, Bristol, UK
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