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Identification of familial hypercholesterolemia in acute coronary syndrome patients: are we missing the mark?
Session:
Posters (Sessão 4 - Écran 8) - Síndromes coronárias agudas em populações especiais
Speaker:
Pedro Brás
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Garcia Brás; Guilherme Portugal; Ana Teresa Timóteo; Bárbara Teixeira; Rita Teixeira; Sofia Jacinto; Alexandra Castelo; Vera Ferreira; Ana Raquel Santos; Francisco Albuquerque; André Ferreira; Isabel Cardoso; José Viegas; André Grazina; Rui Cruz Ferreira
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Introduction: Patients (P) with familial hypercholesterolemia (FH) have considerable elevation in levels of low-density lipoprotein (LDL) cholesterol and a higher risk of premature coronary artery disease and acute coronary syndromes (ACS). However, even in a hospital setting with a high volume of ACS P, the diagnosis of FH frequently goes undetected. The aim of this study was to evaluate the application of the Dutch Lipid Clinic Network (DLCN) Criteria in P admitted for ACS and to analyse ACS recurrence, hospitalization and mortality in a 30-day follow-up.</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Methods: Retrospective evaluation of consecutive patients with ACS enrolled in a single-center prospective ACS registry from 2005 to 2019. Data from the digital files including family history and laboratory tests was analysed and P were followed up for 30 days for hospitalization, recurrent ACS, all-cause mortality and cardiovascular (CV) death. </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Results: A total of 3811 P were evaluated, mean age 63±13 years, 28% female gender, 1497 P (39%) with active smoking habits, 847 P (22%) with diabetes mellitus, 419 P (11%) with family history of coronary disease, 1340 P (35%) with premature coronary artery disease, 53 P (1.4%) with premature cerebral or peripheral vascular disease and 522 (14%) with previous ACS. The mean LDL cholesterol was 125±43 mg/dL, the mean high-density lipoprotein (HDL) cholesterol was 40±16 mg/dL and the mean triglycerides was 132±89 mg/dL. </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">The diagnosis at hospital admission was unstable angina (UA) in 189 P (5%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1024 P (27%) and ST-segment elevation MI (STEMI) in 2598 P (68%). The hospital mortality rate was 4.3% (163P).</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Applying the DLCN criteria, 3089 P (81%) had a score of <3 (“unlikely FH”), 675 P (17.7%) a score of 3 to 5 (“possible FH”), 41 P (1.1%) a score of 6 to 8 (“probable FH”) and 1 P (0.03%) a score of >8 (“definite FH”). Stratifying according to ACS type: among UA P, 31 (16%) had “possible FH” and 4 (2.1%) had “probable FH”. Among NSTEMI P, 145 (14.2%) had “possible FH”, 9 P (0.9%) “probable FH” and 1 P (0.03%) had “definite FH”. Finally, in STEMI P, 497 (19.1%) had “possible FH” and 28 P (1.1%) had “probable FH”.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">In a 30-day follow-up, there was an all-cause mortality rate of 2% (78 P) and a CV death of 1.3 % (49P), while the all-cause hospitalization rate was 3.5% (134P) and the recurrent admission for ACS was 1.7% (65P). The DLCN criteria score was significantly correlated with CV death (OR 1.25, CI 95% 1.04-1.50, p=0.020) and admission for recurrent ACS (OR 1.19, CI 95% 1.04-1.36, p=0.04).</span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Conclusion: Application of the Dutch Lipid Clinic Network criteria in P admitted for ACS revealed 675 P (17.7%) with “possible FH” and 41 P (1.1%) with “probable HF” as well as show significant correlation with CV death and recurrent ACS. Routine assessment of these criteria can be an accessible tool to stratify likelihood of FH and proceed accordingly to genetic testing.</span></span></p>
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