Familial Hypercholesterolemia Cascade: On the Road to Universal Screening

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Matthew Proute MBBS, Nosagie Ohonba MBBS, Jeffery Feldman MD, Robert Fishberg MD, Tiffany Haynes MD
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引用次数: 0

Abstract

Background/Synopsis

The Atlantic Medical Group Lipid Workgroup at Atlantic Health System is composed of both adult and pediatric cardiologists, internists, endocrinologists and nephrologists. The goal of the workgroup is to address the need for optimal cardiometabolic diagnosis and treatment. Because familial hypercholesterolemia (FH) is dominantly inherited, cascade screening of family members can be highly effective.

Objective/Purpose

To highlight the benefits of collaboration of adult and pediatric specialties for the diagnosis and treatment of FH.

Methods

38-year-old female with a strong family history of early CAD, very high cholesterol levels and xanthelasmas presented to us to establish care. Her two children were diagnosed genetically with FH at age 3 and 6 with cholesterol levels of 269 mg/dL and > 400 mg/dL, respectively. She was initiated on treatment with a statin. Her twin sister was also evaluated and found to have high cholesterol levels and xanthelasmas. This sister's children were also suspected of having FH and were referred to a pediatric cardiologist for diagnosis and treatment.

Results

The children of the index patient were found to be heterozygous for deletion (exon17-18) LDLR gene, pathologic for FH.

Conclusions

The collaborative efforts of adult and pediatric specialists make the Atlantic Medical Group Lipid workgroup unique. Through this program, cascade and reverse cascade screening is utilized to identify and diagnose individuals at risk for familial hypercholesterolemia. Identification of an index patient with FH with effective screening of relatives combines the benefits of universal and cascade screening and has the potential of detecting all living cases of FH. Basseling et al found that although capable of identifying asymptomatic individuals with hypercholesterolemia, the cost effectiveness of universal screening has not yet been determined and cascade screening has proven to be more cost effective than any other screening strategy currently available thus far.

家族性高胆固醇血症级联:通往普及筛查之路
背景/简介大西洋医疗系统的大西洋医疗集团血脂工作组由成人和儿童心脏病专家、内科医生、内分泌专家和肾病专家组成。该工作组的目标是满足最佳心脏代谢诊断和治疗的需求。由于家族性高胆固醇血症(FH)是显性遗传,因此对家族成员进行逐级筛查非常有效。目标/目的强调成人和儿科专家合作对 FH 诊断和治疗的益处。她的两个孩子分别在 3 岁和 6 岁时被确诊为遗传性房颤,胆固醇水平分别为 269 毫克/分升和 400 毫克/分升。她开始接受他汀类药物治疗。她的孪生姐妹也接受了评估,发现胆固醇水平较高,并伴有黄疽。该姐妹的孩子也被怀疑患有先天性心脏病,并被转诊至儿科心脏病专家处接受诊断和治疗。通过这项计划,级联和反向级联筛查被用来识别和诊断家族性高胆固醇血症的高危人群。通过对亲属进行有效筛查来识别家族性高胆固醇血症的指标患者,结合了普遍筛查和级联筛查的优点,有可能发现所有在世的家族性高胆固醇血症病例。Basseling 等人发现,虽然普遍筛查能够发现无症状的高胆固醇血症患者,但其成本效益尚未确定,而逐级筛查已被证明比目前可用的任何其他筛查策略都更具成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
6.80%
发文量
209
审稿时长
49 days
期刊介绍: Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
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