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High prevalence of genetic determined familial hypercholesterolemia in premature coronary artery disease

Authors Pirazzi C, Håkansson L, Gustafsson C, Omerovic E, Wiklund O, Mancina RM

Received 26 January 2019

Accepted for publication 14 March 2019

Published 24 May 2019 Volume 2019:12 Pages 71—78

DOI https://doi.org/10.2147/TACG.S202942

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Martin H. Maurer


Carlo Pirazzi,1 Lina Håkansson,1 Carola Gustafsson,1 Elmir Omerovic,1,2 Olov Wiklund,2 Rosellina Margherita Mancina2

1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; 2Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden

Background: Premature coronary artery disease (CAD) is a major cause of mortality and morbidity. Increased low-density lipoprotein-cholesterol (LDL-C) level is a major risk factor for CAD and thus the main target for its prevention. Familial Hypercholesterolemia (FH) is a genetic inherited disorder characterized by high LDL-C, and subsequent premature CAD development. Early drug treatment with lipid-lowering medications in FH prevents cardiovascular disease onset.
   The FH prevalence in the Northern European general population is 0.3%, and it is estimated that it explains 20% of premature CAD cases in individuals with familial clustering. Despite the wide number of papers showing the prevalence of clinical FH in cardiovascular disease, the prevalence of genetic FH in individuals with premature CAD is not yet well known. Here, we examined the prevalence of genetically determined FH in individuals with premature CAD.
Patients and methods: 66 patients who underwent coronary angiography with suspected premature acute coronary syndrome (age <50 years for men and <55 years for women) underwent genetic screening to identify FH-causing mutations. All patients underwent physical and clinical examinations. Information about family and personal history, drug therapy and habits were also collected.
Results: We found FH-causative mutations in 3/66 (4.5%) screened individuals with premature CAD. When considering individuals with confirmed CAD after coronary angiography, the FH mutation prevalence was 6.1% (3/49). After excluding individuals with classical risk factors for CAD other than hypercholesterolemia, the FH mutation prevalence raised to 15.8% (3/19).
Conclusion: In conclusion, we found that individuals with premature CAD have a more than 15-fold increased prevalence of FH mutations compared to the general population.

Keywords: young, myocardial infarction, CAD, acute coronary event, FH

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