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Past, Present, and Future of Familial Hypercholesterolemia Management Cover

Past, Present, and Future of Familial Hypercholesterolemia Management

Methodist DeBakey Cardiovascular Journal
Volume 17 (2021): Issue 4
By:  and    
Open Access
|Sep 2021
Figures & tables

Figures & Tables

Table 1

Biomarkers to identify individuals with familial hypercholesterolemia who are at higher risk of major adverse cardiovascular outcomes. CAC: coronary artery calcification; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; ASCVD: atherosclerotic coronary vascular disease; Lp: lipoprotein; IAS: International Atherosclerosis Society; MESA: Multiethnic Study of Atherosclerosis.

LDL-C AND TREATMENT ONSET10RISK BIOMARKERS32,41RISK EQUATIONS30,35IAS SEVERE FH DEFINITION10CAC SCORES31,39,43

  • Usually ≥ 310 mg/dL

  • Late onset of LDL lowering (> 40 years old)

  • Male sex

  • Older age

  • Smoking

  • Hypertension

  • Diabetes

  • High Lp(a)

  • Low HDL-C

SAFEHEART risk equation30

  • Previous ASCVD

  • On treatment LDL-C (≥ 160 mg/dL)

  • Higher body mass index

  • Lp(a) > 50 mg/dL

  • Hypertension

  • Smoking

MONTREAL FH Score35

  • Age

  • Male sex

  • Low HDL-C

  • Hypertension

  • Smoking

  • Previous ASCVD defined as myocardial infarction, angina, coronary revascularization, nonembolic ischemic stroke, or transitory ischemic attack, and intermittent claudication

  • Advanced subclinical atherosclerosis (CAC > 100 or > 75th percentile for age and sex according to MESA, or computer tomography angiography with obstructions > 50%, presence of nonobstructive plaques in more than one vessel)

  • LDL-C > 400 mg/dL, or LDL-C > 310 mg/dL and one high-risk feature,* or LDL-C > 190 mg/dL and two high-risk features*

  • CAC > 0

  • CAC > 100

[i] * Risk features: age > 40 years without treatment, smoking, male sex, lipoprotein(a) > 125 nmol/L (50 mg/dL), HDL-C < 40 mg/dL), hypertension, diabetes mellitus, family history of early cardiovascular disease in first-degree relatives (age < 55 years in men and < 60 years in women), chronic kidney disease (ie, estimated glomerular filtration rate < 60 mL/min per 1·73 m2, and BMI > 30 kg/m2

DOI: https://doi.org/10.14797/mdcvj.887 | Journal eISSN: 1947-6108
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Language: English
Page range: 28 - 35
Submitted on: Jul 14, 2021
Accepted on: Jul 16, 2021
Published on: Sep 24, 2021
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
cholesterol,
atherosclerosis,
genetics,
calcium score,
statins,
PCSK9

© 2021 Viviane Z. Rocha, Raul D. Santos, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 17 (2021): Issue 4
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