ABSTRACT
PURPOSE: This study assesses the success of the recently terminated Dutch nationwide cascade screening by examining whether children with familial hypercholesterolemia (FH) were identified through family screening or due to cardiovascular (CVD) events in the FH parent. METHODS: We collected clinical information of all children (0-18 years) with FH with a pathogenic variant at our outpatient lipid clinic between 1992 and 2014 and their FH parents and FH grandparents. RESULTS: We analysed 292 FH children from 205 parents with FH. A history of premature CVD was present in 20% of the parents (29% of the fathers, 9% of the mothers) and 49% of the FH grandparents. CONCLUSION: The fact that CVD is still a presenting event of FH in especially fathers shows that nationwide screening might have been terminated too early. Therefore we recommend to proceed the cascade screening.
Subject(s)
Hyperlipoproteinemia Type II/diagnosis , Mass Screening/methods , Adolescent , Apolipoprotein B-100/genetics , Cardiovascular Diseases/diagnosis , Child , Child, Preschool , Fathers , Female , Genetic Predisposition to Disease , Genetic Variation , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Infant , Infant, Newborn , Male , Netherlands , Parents , Pedigree , Receptors, LDL/genetics , Risk FactorsABSTRACT
Dyslipidemia is a major risk factor for cardiovascular disease. This review addresses why, who and when to test for dyslipidemia. The essence why to test lipids is that those individuals recognized to potentially benefit from primary cardiovascular risk prevention, have a complete cardiovascular risk assessment. Who and when to test lipids differs among the major European, English and American guidelines regarding the recommended age and approach. It is important to note that the threshold and the frequency in whom to perform risk assessment is not established. Most important in decisions concerning lipid testing is communication and to involve individual circumstances.
Subject(s)
Dyslipidemias/diagnosis , Lipids/blood , Cardiovascular Diseases/etiology , Dyslipidemias/blood , Dyslipidemias/complications , Humans , Primary Prevention , Risk AssessmentABSTRACT
PURPOSE: Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with a high risk of premature coronary heart disease (CHD). CHD prevention consists of lifestyle changes combined with lifelong statin treatment. Good adherence to statins reduces the risk of events substantially. This study was designed to identify determinants of non-adherence and to develop a model predicting non-adherence. METHODS: A single centre survey included all consecutive heterozygous FH patients above age 18 years, who were treated by a specialized team in the outpatient clinic of a university hospital in The Netherlands between 2008 and 2009. In addition to clinical data, patients completed a questionnaire concerning medication adherence. RESULTS: We analyzed 321 patients (169 women) with a statin prescription whose mean age was 46 ± 14 years (± S.D.), and 13 % of the patients had CHD. The untreated mean total cholesterol was 10 ± 2.3 mmol/l. On average, patients were ten years on cholesterol-lowering therapy (range 1-29 years). Adherence was reported by 89 % of the patients (> 90 % adherence). Non-adherence was associated with younger age (OR = 10.64, 95 % CI 2.86-39.68), high total cholesterol level during prescription (OR = 4.29, 95 % CI 1.86-9.89) and a relatively low untreated total cholesterol level (OR = 3.94 95 % CI 1.39-11.14). A prediction model based on these three determinants had a c-index of 0.78 and a calibration with P = 0.88. CONCLUSION: Based on three independent determinants, a prediction model is developed to identify non-adherent FH patients. This model needs to be tested in future prospective research. It might be a first step in improving statin adherence in this extremely high risk group.
