RESUMEN
BACKGROUND AND AIMS: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. METHODS: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. RESULTS: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in â¼2/3 countries. Lipoprotein-apheresis is offered in â¼60% countries, although access is limited. CONCLUSIONS: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.
Asunto(s)
Anticolesterolemiantes/uso terapéutico , Eliminación de Componentes Sanguíneos , Salud Global , Hiperlipoproteinemia Tipo II/terapia , Cooperación Internacional , Anticolesterolemiantes/efectos adversos , Biomarcadores/sangre , Eliminación de Componentes Sanguíneos/efectos adversos , LDL-Colesterol/sangre , Conducta Cooperativa , Predisposición Genética a la Enfermedad , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Hiperlipoproteinemia Tipo II/sangre , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/epidemiología , Fenotipo , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: The potential for global collaborations to better inform public health policy regarding major non-communicable diseases has been successfully demonstrated by several large-scale international consortia. However, the true public health impact of familial hypercholesterolaemia (FH), a common genetic disorder associated with premature cardiovascular disease, is yet to be reliably ascertained using similar approaches. The European Atherosclerosis Society FH Studies Collaboration (EAS FHSC) is a new initiative of international stakeholders which will help establish a global FH registry to generate large-scale, robust data on the burden of FH worldwide. METHODS: The EAS FHSC will maximise the potential exploitation of currently available and future FH data (retrospective and prospective) by bringing together regional/national/international data sources with access to individuals with a clinical and/or genetic diagnosis of heterozygous or homozygous FH. A novel bespoke electronic platform and FH Data Warehouse will be developed to allow secure data sharing, validation, cleaning, pooling, harmonisation and analysis irrespective of the source or format. Standard statistical procedures will allow us to investigate cross-sectional associations, patterns of real-world practice, trends over time, and analyse risk and outcomes (e.g. cardiovascular outcomes, all-cause death), accounting for potential confounders and subgroup effects. CONCLUSIONS: The EAS FHSC represents an excellent opportunity to integrate individual efforts across the world to tackle the global burden of FH. The information garnered from the registry will help reduce gaps in knowledge, inform best practices, assist in clinical trials design, support clinical guidelines and policies development, and ultimately improve the care of FH patients.
Asunto(s)
Prestación Integrada de Atención de Salud , Hiperlipoproteinemia Tipo II/terapia , Cooperación Internacional , Brechas de la Práctica Profesional , Sistema de Registros , Proyectos de Investigación , Acceso a la Información , Conducta Cooperativa , Minería de Datos , Prestación Integrada de Atención de Salud/organización & administración , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/genética , Hiperlipoproteinemia Tipo II/mortalidad , Almacenamiento y Recuperación de la Información , Objetivos Organizacionales , Resultado del TratamientoRESUMEN
Evaluar la capacidad predictiva de la medición de la dispersión del QTc de presentar arritmias post-infarto del miocardio (IM). Estudio restrospectivo, descriptivo con comparaciones intragrupales de una muestrta de 28 pacientes, edad promedio de 53,33, cuya muestra fue tomada desde enero a septiembre de 1998, con dignóstico de IM según criterios de la New York Heart Associatio, realizándose seguimientos a todos los pacientes durante los 4 primeros días posterior a su ingreso, un total de 8 EKG por paciente midiéndose el intervalo QT en todas las derivaciones de cada EKG, QTc según, fórmula de Bazett y dispersión del mismo, la cual se obtuvo restando al máximo valor del Qtc menos el mínimo. Se compararon estos resultados con los obtenidos del Holter, estableciendo por los métodos estadísticos análisis de varianza y T de Student pareada, que para el cuarto día de estudio hubo diferencia estadísticamente significativa entre los grupos comparados en cuanto al comportamiento de su dispersión. El mantenerse disperso aún en el cuarto día de estudio pudiera relacionarse con riesgo de arritmia post IM