Author + information
- Ashwini Bhat,
- Parvathi Balachandran,
- Carin Smith,
- Maya Safarova and
- Iftikhar Kullo
Background: The association of Familial Hypercholesterolemia (FH) with coronary heart disease (CHD) has not been studied in a community based setting in the United States. We sought to profile the association of FH with CHD, lag in diagnosis and treatment gap in Olmsted County, MN.
Methods: 6000 individuals identified with Low Density Lipoprotein cholesterol (LDL-C) ≥ 155 mg/dl from the Employee and Community Health cohort at Mayo Clinic (excluding those with secondary causes of hypercholesterolemia), were scored according to the Dutch Lipid Clinic Network (DLCN) criteria. Those with DLCN score ≥ 6 were labelled as FH cases. CHD presence and risk factors were ascertained from the medical records of 150 FH cases and 297 age and sex matched controls. Multivariate logistic regression models were used to calculate the odds ratio (OR) for CHD with adjustment for conventional risk factors. The proportion of FH cases that were diagnosed and the LDL-C reduction from index date served as measures of detection and control.
Results: Of the 150 FH cases, 28 were diagnosed at an average age of 37 years. The average LDL-C reduction was 49.8% with only 28% of patients achieving target levels (<100 mg/dl, < 70 mg/dl in presence of CHD) over a median follow-up of 12 years. After covariate adjustment, the OR for CHD associated with FH was 4.69 (3.08-7.23, p ≤ 0.001). The OR for premature CHD was 11.91 (7.1-20.4, p ≤ 0.0001). The mean age at the first CHD event was 55 in females and 47 in males with an average of 1.8 CHD events and 1.5 coronary revascularization procedures in FH cases. Contrary to prior studies, the prevalence of type 2 diabetes was higher in cases (27%) than in controls (14%) (p ≤ 0.001). There was high prevalence of obesity in both groups (59%, 56%).
Conclusions: Despite the significant association with premature CHD, FH cases were under diagnosed. Although the average LDL-C reduction was 50%, less than a third achieved target levels. There is an urgent need to increase awareness and detection of FH in the community to institute earlier and more aggressive therapy to achieve target LDL-C levels.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Contemporary Issues in Familial Hypercholesterolemia
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1304M-07
- 2017 American College of Cardiology Foundation