Heartbeat: improved diagnosis of familial hypercholesterolaemia

Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA;cmotto@uw.edu Familial hypercholesterolaemia (FH) is the most common autosomal dominant genetic condition, affecting about 1 in 250 people, caused by a pathogenic variant in one of several genes involved in lipoprotein cholesterol catabolism. The FAMCAT score is based on systematic screening of routine primary care records for cholesterol measurements, age, triglycerides, family history, diabetes, kidney disease and current use of lipid-lowering drugs (figure 1). CVD, cardiovascular disease;DLCN, Dutch Lipid Clinic Network;FAMCAT, FH Case Ascertainment Tool;FH, familial hypercholesterolaemia;GP, general practitioner;HCA, healthcare assistant;LLT, lipid-lowering treatment;VUS, variant of unknown significance.

Heartbeat: the global burden of atrial fibrillation and ensuring anticoagulation persistence

The current study from China highlights the importance of social determinants of health in AF epidemiology, including residential environment (ie, urban vs rural), availability of care and treatment access, and socioeconomic position, as well as cultural and language aspects (figure 1). The editorial authors identify a research gap in studies of methods to ensure adherence to OAC therapy and conclude that ‘quality research on maintaining persistence is required to guide effective interventions to achieve the full benefit of thrombophylactic therapy in AF, and contribute to further reductions in stroke among patients with AF.’ Another interesting study in this issue of Heart reports the use of automated echocardiographic global longitudinal strain (GLS) analysis in asymptomatic patients with aortic stenosis.5 In a series of 340 patients followed for a median of 24 months, 46 reached the primary endpoint (a composite of cardiac death, heart failure hospitalisation, myocardial infarction or ventricular tachyarrhythmia) and 62 underwent aortic valve surgery.

Heartbeat: diagnosis and management of pericardial disease

[...]in this issue of Heart is a short summary of the key changes in the European Society of Cardiology 2020 Guidelines for management of acute coronary syndromes without ST-elevation.5 A few of the major points are use of 0 and 1 hours rapid rule-out protocols, a preference for prasugrel over ticagrelor in patients undergoing invasive intervention, delayed angiography after resuscitated out-of-hospital cardiac arrest in haemodynamically stable patients and consideration of complete revascularisation in patients with multivessel disease who are not in cardiogenic shock. The unfolding story of the interaction between the COVID-19 pandemic and cardiovascular mortality is addressed in a systematic review and meta-analysis showing that despite reduced rates of admission for ST-elevation myocardial infarction (STEMI) during the COVID-19 pandemic, hospital mortality was unchanged.6 Danchin and Marijon7 express the concern that although this apparent decrease in STEMI might be due to an actual decrease in event rates, it also is possible that ‘if the decrease was primarily due to fear of getting admitted in patients actually having had an AMI, we should observe an unusually increased rate in late complications potentially related to larger myocardial infarctions caused by the lack of appropriate management at the acute stage (eg, congestive heart failure or ventricular arrhythmias).’ The article then focuses on multimodality imaging for ischaemic heart disease;discussing the strengths and limitation of exercise treadmill testing, coronary CT angiography, exercise or pharmacological single-photon emission (SPECT), or positron emission tomographic (PET) myocardial perfusion imaging, stress cardiovascular magnetic resonance or stress echocardiography.