Residues in the Fructose Binding Pocket Are Required for Ketohexokinase-A Activity.

Excessive fructose consumption is a primary contributor to the global surges in obesity, cancer, and metabolic syndrome. Fructolysis is not robustly regulated and is initiated by ketohexokinase (KHK). In this study, we determined the crystal structure of KHK-A, one of two human isozymes of KHK, in the apo-state at 1.85 Å resolution, and we investigated the roles of residues in the fructose-binding pocket by mutational analysis. Introducing alanine at D15, N42, or N45 inactivated KHK-A, whereas mutating R141 or K174 reduced activity and thermodynamic stability. Kinetic studies revealed that the R141A and K174A mutations reduced fructose affinity by 2- to 4-fold compared to WT KHK-A, without affecting ATP affinity. Molecular dynamics simulations provided mechanistic insights into the potential roles of the mutated residues in ligand coordination and the maintenance of an open state in one monomer and a closed state in the other. Protein-protein interactome analysis indicated distinct expression patterns and downregulation of partner proteins in different tumor tissues, warranting a re-evaluation of KHK's role in cancer development and progression. The connections between different cancer genes and the KHK signaling pathway suggest that KHK is a potential target for preventing cancer metastasis. This study enhances our understanding of KHK-A's structure and function and offers valuable insights into potential targets for developing treatments for obesity, cancer, and metabolic syndrome.

Microbial Colonization of Explants after Osteosynthesis in Small Animals: Incidence and Influencing Factors.

Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and continue to be among the most common surgical complications, leading to delayed fracture healing, osteomyelitis, implant loosening, and loss of function. Osteosynthesis implants are routinely utilized in veterinary medicine and the current study investigates the microbial colonization of implants following osteosynthesis in small animals, along with its incidence and influencing factors. The results are analyzed in regard to correlations between infection, patient, disease progression, and radiographic images, as well as other factors that may promote infection. Seventy-one explants from sixty-five patients were examined and evaluated for microbial colonization. Factors like body weight and age, location and type of plate and additional injuries like lung lesions, the surgeon's experience, or the number of people present during the surgical procedure seem to influence the development of an infection. Of the animals, 60% showed osteolytic changes and 73.3% of those with dysfunctional mobility had an implant infection. Microorganisms were detected in almost 50% of the explants, but a clinically relevant infection was only present in five patients (7.3%), suggesting that the presence of microorganisms on an implant does not necessarily lead to treatment complications.

Evaluating the impact of modeling the family effect for clonal selection in potato-breeding programs.

Because of its wide distribution, high yield potential, and short cycle, the potato has become essential for global food security. However, the complexity of tetrasomic inheritance, the high level of heterozygosity of the parents, the low multiplication rate of tubers, and the genotype-by-environment interactions impose severe challenges on tetraploid potato-breeding programs. The initial stages of selection take place in experiments with low selection accuracy for many of the quantitative traits of interest, for example, tuber yield. The goal of this study was to investigate the contribution of incorporating a family effect in the estimation of the total genotypic effect and selection of clones in the initial stage of a potato-breeding program. The evaluation included single trials (STs) and multi-environment trials (METs). A total of 1,280 clones from 67 full-sib families from the potato-breeding program at Universidade Federal de Lavras were evaluated for the traits total tuber yield and specific gravity. These clones were distributed in six evaluated trials that varied according to the heat stress level: without heat stress, moderate heat stress, and high heat stress. To verify the importance of the family effect, models with and without the family effect were compared for the analysis of ST and MET data for both traits. The models that included the family effect were better adjusted in the ST and MET data analyses for both traits, except when the family effect was not significant. Furthermore, the inclusion of the family effect increased the selective efficiency of clones in both ST and MET analyses via an increase in the accuracy of the total genotypic value. These same models also allowed the prediction of clone effects more realistically, as the variance components associated with family and clone effects within a family were not confounded. Thus, clonal selection based on the total genotypic value, combining the effects of family and clones within a family, proved to be a good alternative for potato-breeding programs that can accommodate the logistic and data tracking required in the breeding program.

Indications for the removal of implants after fracture healing: A comparison between human and veterinary medicine.

Indications for implant removal after fracture healing are still under debate in both human and veterinary medicine. Although hardware removal is a common procedure, it should not be undertaken lightly. Intra and post-operative complications are common and a thorough evaluation of the risks and benefits should be performed. This review aimed to collect and summarise published data on the indications for implant removal in small animals, compare the collected data with human and equine medicine, and investigate the existence of guidelines for this purpose. There is no international consensual agreement for implant removal after fracture healing, neither in small animals nor in human orthopaedics. Decision-making processes are still controversial in some scenarios, thus clear evidence-based protocols for implant removal are needed.

Genomic prediction for complex traits across multiples harvests in alfalfa (Medicago sativa L.) is enhanced by enviromics.

Breeding for dry matter yield and persistence in alfalfa (Medicago sativa L.) can take several years as these traits must be evaluated under multiple harvests. Therefore, genotype-by-harvest interaction should be incorporated into genomic prediction models to explore genotypes' adaptability and stability. In this study, we investigated how enviromics could help to predict the genotypic performance under multiharvest alfalfa breeding trials by evaluating 177 families across 11 harvests under four cross-validation scenarios. All scenarios were analyzed using six models in a Bayesian mixed model framework. Our results demonstrate that models accounting to the enviromics information led to an increase of genetic variance and a decrease in the error variance, indicating better biological explanation when the enviromic information was incorporated. Furthermore, models that accounted for enviromic data led to higher predictive ability (PA) in a reduced number of harvests used in the training data set. The best enviromic models (M2 and M3) outperformed the base model (GBLUP model-M0) for predicting adaptability and persistence across all cross-validation scenarios. Incorporating environmental covariates also provided higher PA for persistence compared with the base model, as predictions increased from 0 to 0.16, 0.20, 0.56, and 0.46 for CV00, CV1, CV0, and CV2. The results also demonstrate that GBLUP without enviromics term has low power to predict persistence, thus the adoption of enviromics is a cheap and efficient alternative to increase accuracy and biological meaning.

Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study.

BACKGROUND: We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). METHODS: We used data from a prospective community cohort of young people assessed at baseline (M = 9.7 years, SD = 1.9), first (M = 13.5 years, SD = 1.9), and second (M = 18.2 years, SD = 2.0) follow-ups (N = 1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLE was measured using the Life History instrument. Psychiatric diagnoses were evaluated using the Development and Well-Being Assessment. Latent growth models investigated the association between poverty at baseline and the growth of any MHD, externalizing, and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by exposure to SLE. RESULTS: Poverty affected 11.4% of the sample at baseline and was associated with an increased propensity for presenting externalizing disorders in adolescence or early adulthood (standardized estimate = 0.27, p = 0.016). This association was not significant for any disorder or internalizing disorders. Childhood poverty increased the likelihood of externalizing disorders in early adulthood through higher exposure to SLE (OR = 1.07, 95 CI% 1.01-1.14). Results were only replicated among females in stratified analyses. CONCLUSIONS: Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that need to be tackled to reduce the burden of externalizing disorders in young people.

Systematic analysis of different degrees of haemolysis on miRNA levels in serum and serum-derived extracellular vesicles from dogs.

BACKGROUND: Circulating microRNAs (miRNAs) are described as promising non-invasive biomarkers for diagnostics and therapeutics. Human studies have shown that haemolysis occurring during blood collection or due to improper sample processing/storage significantly alters the miRNA content in plasma and serum. Nevertheless, no similar research has been performed in dogs so far. We therefore investigated the effects of different degrees of haemolysis on the levels of selected miRNAs in serum and serum-derived extracellular vesicles (EVs) from dogs, by inducing a controlled in vitro haemolysis experiment. RESULTS: The abundance of miR-16, miR-92a, miR-191, miR-451 and miR-486 was significantly sensitive to haemolysis in serum and serum-derived EVs, while other selected miRNAs were not influenced by haemolysis. Furthermore, we found that the abundance of some canine miRNAs differs from data reported in the human system. CONCLUSIONS: Our results describe for the first time the impact of haemolysis on circulating miRNAs not only in whole serum, but also in serum-derived EVs from dogs. Hence, we provide novel data for further analyses in the discovery of canine circulating biomarkers. Our findings suggest that haemolysis should be carefully assessed to assure accuracy when investigating circulating miRNA in serum or plasma-based tests.

Childhood individual and family modifiable risk factors for criminal conviction: a 7-year cohort study from Brazil.

Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5-14 years, n = 2511) and criminal conviction at a 7-year follow-up (13-21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38-12.46) with a PARF of 22.5% (95% CI 5.9-36.1%). It suggests that preventing children's exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth.

Adaptação transcultural de uma escala de satisfação dos moradores com os serviços das residências terapêuticas / Transcultural adaptation of a satisfaction scale for the residents of therapeutic residences / Adaptación transcultural de una escala de satisfacción de residentes en cuanto a los servicios de residencias terapéuticas

A satisfação dos usuários constitui um dos critérios da qualidade dos serviços de saúde mental. Entretanto, há uma carência de estudos avaliando a satisfação dos moradores de residências terapêuticas (RTs) e ausência de instrumento de medida específico para este fim, no Brasil. Neste estudo, foi feita a adaptação transcultural do Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), para avaliar a satisfação dos moradores das RTs. O procedimento incluiu: tradução da escala original, retradução, revisão por Comitê de Especialistas e Estudo Piloto com 30 moradores de RTs do município de Barbacena/MG. Os resultados incluíram correções a partir das traduções e retraduções e adaptação da escala pelo Comitê de Especialistas, assim como modificações na redação de algumas questões, no Estudo Piloto. A versão final possui equivalência semântica e conceitual com a escala original e está adaptada ao contexto brasileiro, sendo de fácil compreensão para a população-alvo.

Users' satisfaction is a measure of mental health services quality. However, few studies evaluated residents' satisfaction regarding the Therapeutic Residences (TR) and there is no specific instrument in brazilian context for this evaluation. In this study, we made the transcultural adaptation of the Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), to evaluate the residents' satisfaction in the TR. The procedure included: translation of the original scale, re-translation, analyses by an Expert Commitee and a Pilot Study with 30 TR residents in the city of Barbacena-MG. Results showed corrections of the translations and retranslations and adaptation of the scale by the Expert Commitee and modifications in the questions wording during the Pilot Study. The final version of the scale has semantic and conceptual equivalence with the original scale, is adapted to the brazilian context and is easy to understand by the target population.

La satisfacción de los usuarios es un criterio de calidad de los servicios de salud mental. Sin embargo, faltan estudios que evalúen la satisfacción de los residentes de residencias terapéuticas (RTs) y en Brasil hay ausencia de un instrumento de medición específico para este fin. Este estudio adaptó el Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), para evaluar la satisfacción de los residentes de las RTs. El procedimiento incluyó: traducción de la escala original, retraducción, revisión por el Comité de Especialistas y Estudio Piloto con 30 residentes en Barbacena-MG. Los resultados mostraron correcciones de traducciones y retraducciones, y adaptación de la escala por parte del Comité de Especialistas, y cambios en la redacción de las preguntas, en el Estudio Piloto. La versión final tiene equivalencia semántica y conceptual con la escala original y está adaptada al contexto brasileño, siendo de fácil comprensión para el público de RTs.

Genomic prediction for canopy height and dry matter yield in alfalfa using family bulks.

Genomic selection (GS) has proven to be an effective method to increase genetic gain rates and accelerate breeding cycles in many crop species. However, its implementation requires large investments to phenotype of the training population and for routine genotyping. Alfalfa (Medicago sativa L.) is one of the major cultivated forage legumes, showing high-quality nutritional value. Alfalfa breeding is usually carried out by phenotypic recurrent selection and is commonly done at the family level. The application of GS in alfalfa could be simplified and less costly by genotyping and phenotyping families in bulks. For this study, an alfalfa reference population composed of 142 full-sib and 35 half-sib families was bulk-genotyped using target enrichment sequencing and phenotyped for dry matter yield (DMY) and canopy height (CH) in Florida, USA. Genotyping of the family bulks with 17,707 targeted probes resulted in 114,945 single-nucleotide polymorphisms. The markers revealed a population structure that matched the mating design, and the linkage disequilibrium slowly decayed in this breeding population. After exploring multiple prediction scenarios, a strategy was proposed including data from multiple harvests and accounting for the G×E in the training population, which led to a higher predictive ability of up to 38 and 24% for DMY and CH, respectively. Although this study focused on the implementation of GS in alfalfa families, the bulk methodology and the prediction schemes used herein could guide future studies in alfalfa and other crops bred in bulks.

Gamma-Band Frequency Analysis and Motor Development in Music-Trained Children: A Cross-Sectional Study.

Background: The aim of this study was to analyze the gamma-band frequency and motor performance of children with and without music training.Methods: This cross-sectional study included 31 right-handed children, 6-11 years old, who were allocated to two groups: 1) the music group (MG), including children who attended preschool and musical training (n = 16), and 2) the no-music group (NMG), including children who attended preschool but received no additional music training (n = 15). The outcomes were gamma-band frequency measured by electroencephalography, manual dexterity, aim-and-catch, and static and dynamic balance abilities measured by the Movement Assessment Battery for Children, and fine motor skills, overall motor skills, balance, corporal body scheme, spatial organization, temporal orientation, and general motor quotient (GMQ) by a Brazilian scale for motor development.Results: There 1was a significant difference between groups in the peak frequency (p = 0.0195) and median frequency (p = 0.0070) in the F3-F4 regions. Static and dynamic balance (p = 0.03), temporal orientation (p < 0.01), and GMQ (p < 0.03) were higher in MG than in NMG.Conclusion: The musically trained children had increased gamma-peak frequency in the frontal region and greater temporal orientation, balance, and the overall motor quotient.

Phenomics-Assisted Selection for Herbage Accumulation in Alfalfa (Medicago sativa L.).

The application of remote sensing in plant breeding is becoming a routine method for fast and non-destructive high-throughput phenotyping (HTP) using unmanned aerial vehicles (UAVs) equipped with sensors. Alfalfa (Medicago sativa L.) is a perennial forage legume grown in more than 30 million hectares worldwide. Breeding alfalfa for herbage accumulation (HA) requires frequent and multiple phenotyping efforts, which is laborious and costly. The objective of this study was to assess the efficiency of UAV-based imagery and spatial analysis in the selection of alfalfa for HA. The alfalfa breeding population was composed of 145 full-sib and 34 half-sib families, and the experimental design was a row-column with augmented representation of controls. The experiment was established in November 2017, and HA was harvested four times between August 2018 and January 2019. A UAV equipped with a multispectral camera was used for HTP before each harvest. Four vegetation indices (VIs) were calculated from the UAV-based images: NDVI, NDRE, GNDVI, and GRVI. All VIs showed a high correlation with HA, and VIs predicted HA with moderate accuracy. HA and NDVI were used for further analyses to calculate the genetic parameters using linear mixed models. The spatial analysis had a significant effect in both dimensions (rows and columns) for HA and NDVI, resulting in improvements in the estimation of genetic parameters. Univariate models for NDVI and HA, and bivariate models, were fit to predict family performance for scenarios with various levels of HA data (simulated in silico by assigning missing values to full dataset). The bivariate models provided higher correlation among predicted values, higher coincidence for selection, and higher genetic gain even for scenarios with only 30% of HA data. Hence, HTP is a reliable and efficient method to aid alfalfa phenotyping to improve HA. Additionally, the use of spatial analysis can also improve the accuracy of selection in breeding trials.

Genomic prediction in family bulks using different traits and cross-validations in pine.

Genomic prediction integrates statistical, genomic, and computational tools to improve the estimation of breeding values and increase genetic gain. Due to the broad diversity in mating systems, breeding schemes, propagation methods, and unit of selection, no universal genomic prediction approach can be applied in all crops. In a genome-wide family prediction (GWFP) approach, the family is the basic unit of selection. We tested GWFP in two loblolly pine (Pinus taeda L.) datasets: a breeding population composed of 63 full-sib families (5-20 individuals per family), and a simulated population with the same pedigree structure. In both populations, phenotypic and genomic data was pooled at the family level in silico. Marker effects were estimated to compute genomic estimated breeding values (GEBV) at the individual and family (GWFP) levels. Less than six individuals per family produced inaccurate estimates of family phenotypic performance and allele frequency. Tested across different scenarios, GWFP predictive ability was higher than those for GEBV in both populations. Validation sets composed of families with similar phenotypic mean and variance as the training population yielded predictions consistently higher and more accurate than other validation sets. Results revealed potential for applying GWFP in breeding programs whose selection unit are family, and for systems where family can serve as training sets. The GWFP approach is well suited for crops that are routinely genotyped and phenotyped at the plot-level, but it can be extended to other breeding programs. Higher predictive ability obtained with GWFP would motivate the application of genomic prediction in these situations.

Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico.

AIMS: Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1). METHODS: Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up. RESULTS: We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control. CONCLUSIONS: Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.

Brief online behavioral cognitive intervention for anxiety symptoms: what was learned during and for after the pandemic period?

Cognitive therapies comprise a widely recognized group of psychological interventions with considerable empirical support for different mental health conditions. These interventions can be used both in a traditional clinical setting and in crisis situations, especially those involving self-perception of overestimated risk, high vulnerability, and low coping capacity. The world is currently under a crisis, specifically, the COVID-19 pandemic, which can bring substantial impact on people's routine and cause significant psychological distress. In this context, telehealth interventions are becoming a standard practice and, thus, cognitive therapists could also support patients and people in the general population using this tool for the emerging issues. This text provides a brief overview of the main issues that may arise in the current pandemic situation as possible targets for the practice of cognitive therapists and the main evidence-based strategies that could be used in this context.(AU)

As terapias cognitivas compreendem um grupo amplamente reconhecido de intervenções psicológicas, com considerável suporte empírico para diferentes condições de saúde mental. Essas intervenções podem ser utilizadas tanto em ambiente clínico tradicional quanto em situações de crise, principalmente aquelas envolvendo autopercepção de risco superestimado, alta vulnerabilidade e baixa capacidade de enfrentamento. O mundo vive atualmente uma situação de crise, especificamente, a pandemia de COVID-19, que pode trazer um impacto substancial na rotina das pessoas e causar sofrimento psicológico significativo. Nesse contexto, as intervenções de cuidado online estão se tornando uma prática padrão e, assim, os terapeutas cognitivos também poderiam apoiar seus pacientes e pessoas da população em geral usando esta ferramenta para as questões emergentes. Este texto fornece uma breve visão geral das principais questões que podem surgir na atual situação de pandemia como possíveis alvos para a prática de terapeutas cognitivos e as principais estratégias baseadas em evidências que podem ser utilizadas por eles neste contexto.(AU)

Las terapias cognitivas comprenden un grupo ampliamente reconocido de intervenciones psicológicas, con considerable apoyo empírico para diferentes condiciones de salud mental. Estas intervenciones pueden utilizarse tanto en un entorno clínico tradicional como en situaciones de crisis, especialmente aquellas que implican un riesgo auto percibido sobrestimado, alta vulnerabilidad y baja capacidad de afrontamiento. El mundo atraviesa actualmente una situación de crisis, específicamente la pandemia de COVID-19, que puede tener un impacto sustancial en la rutina de las personas y causar una angustia psicológica significativa. En este contexto, las intervenciones de atención en línea se están convirtiendo en una práctica estándar y, por lo tanto, los terapeutas cognitivos también podrían ayudar a sus pacientes y personas en la población general utilizando esta herramienta para problemas emergentes. Este texto ofrece una breve descripción de los principales problemas que pueden surgir en la situación pandémica actual como posibles objetivos para la práctica de los terapeutas cognitivos y las principales estrategias basadas en la evidencia que pueden ser utilizadas por ellos en este contexto.(AU)

Evaluation of Ongoing Participation of People with Schizophrenia in a Mutual Support Group as a Complementary Intervention to Outpatient Psychiatric Treatment.

This study aims to evaluate a group of people with schizophrenia undergoing outpatient treatment and who participate in a mutual support intervention, compared to another group of people with the same diagnosis, but attending only the usual outpatient treatment. This is a prospective study, with two measurements between six months. The mutual support group was initially composed of 16 people and the treatment as usual group was composed of 15 people. Clinical (medication adherence and functioning) and Recovery (hope, well-being, recovery and internalized stigma) outcomes were assessed. Nonparametric tests were used to verify differences in measurements between groups and between two moments. A higher level of internalized stigma and a decrease in the adherence to drug treatment in the treatment as usual group were verified. When comparing the pre-post difference between groups, there was a greater increase in adherence to drug treatment in the mutual support group. Our data point to more favorable results in the mutual support group, showing that ongoing participation in these groups is an important tool for the recovery process and for the treatment itself.

Familial hypercholesterolemia in Mexico: Initial insights from the national registry.

BACKGROUND: Familial hypercholesterolemia (FH) remains underdiagnosed and undertreated. OBJECTIVE: Report the results of the first years (2017-2019) of the Mexican FH registry. METHODS: There are 60 investigators, representing 28 federal states, participating in the registry. The variables included are in accordance with the European Atherosclerosis Society (EAS) FH recommendations. RESULTS: To date, 709 patients have been registered, only 336 patients with complete data fields are presented. The mean age is 50 (36-62) years and the average time since diagnosis is 4 (IQR: 2-16) years. Genetic testing is recorded in 26.9%. Tendon xanthomas are present in 43.2%. The prevalence of type 2 diabetes is 11.3% and that of premature CAD is 9.8%. Index cases, male gender, hypertension and smoking were associated with premature CAD. The median lipoprotein (a) level is 30.5 (IQR 10.8-80.7) mg/dl. Statins and co-administration with ezetimibe were recorded in 88.1% and 35.7% respectively. A combined treatment target (50% reduction in LDL-C and an LDL-C <100 mg/dl) was achieved by 13.7%. Associated factors were index case (OR 3.6, 95%CI 1.69-8.73, P = .002), combination therapy (OR 2.4, 95%CI 1.23-4.90, P = .011), type 2 diabetes (OR 2.8, 95%CI 1.03-7.59, P = .036) and age (OR 1.023, 95%CI 1.01-1.05, P = .033). CONCLUSION: The results confirm late diagnosis, a lower than expected prevalence and risk of ASCVD, a higher than expected prevalence of type 2 diabetes and undertreatment, with relatively few patients reaching goals. Recommendations include, the use of combination lipid lowering therapy, control of comorbid conditions and more frequent genetic testing in the future.