Estimating the Prevalence of Familial Hypercholesterolemia in Acute Coronary Syndrome: A Systematic Review and Meta-analysis.
Journal
The Canadian journal of cardiology
ISSN: 1916-7075
Titre abrégé: Can J Cardiol
Pays: England
ID NLM: 8510280
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
13
05
2019
revised:
19
06
2019
accepted:
19
06
2019
pubmed:
11
9
2019
medline:
15
5
2020
entrez:
11
9
2019
Statut:
ppublish
Résumé
Heterozygous familial hypercholesterolemia (FH) is one of the most common monogenic conditions but remains substantially underdiagnosed. One method for increasing the diagnosis is via opportunistic screening of individuals presenting with acute coronary syndrome (ACS). The prevalence of FH in the ACS population has been assessed in numerous studies using various diagnostic criteria, resulting in wide variability of prevalence estimates. The purpose of this study was to perform a systematic review and meta-analysis to provide a more robust estimate. We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify peer-reviewed articles reporting the prevalence of FH in ACS. We calculated pooled prevalence using a random-effects model. When multiple diagnostic criteria were used in a single study, we gave priority to DNA-based criteria, followed by Dutch Lipid Clinic Network (DLCN) criteria. We also investigated the prevalence in subanalyses according to age and diagnostic criteria. The overall pooled prevalence of FH in ACS, derived from 22 studies, was 4.7% (95% confidence interval [CI], 3.0-7.3). DNA-based criteria and DLCN criteria provided similar estimates of 5.0% (95% CI, 2.6-9.3) and 5.5% (95% CI, 3.0-10.0), respectively. The prevalence was 7.3% (95% CI, 5.3-10.0) for patients aged ≤ 60 years and increased to 13.7% (95% CI, 8.2-22.1) for those aged ≤45 years. Approximately 1 in 21 patients with ACS has FH, and this increases to 1 in 7 among those ≤45 years. These results reinforce the importance of screening for FH in the ACS population.
Sections du résumé
BACKGROUND
Heterozygous familial hypercholesterolemia (FH) is one of the most common monogenic conditions but remains substantially underdiagnosed. One method for increasing the diagnosis is via opportunistic screening of individuals presenting with acute coronary syndrome (ACS). The prevalence of FH in the ACS population has been assessed in numerous studies using various diagnostic criteria, resulting in wide variability of prevalence estimates. The purpose of this study was to perform a systematic review and meta-analysis to provide a more robust estimate.
METHODS
We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify peer-reviewed articles reporting the prevalence of FH in ACS. We calculated pooled prevalence using a random-effects model. When multiple diagnostic criteria were used in a single study, we gave priority to DNA-based criteria, followed by Dutch Lipid Clinic Network (DLCN) criteria. We also investigated the prevalence in subanalyses according to age and diagnostic criteria.
RESULTS
The overall pooled prevalence of FH in ACS, derived from 22 studies, was 4.7% (95% confidence interval [CI], 3.0-7.3). DNA-based criteria and DLCN criteria provided similar estimates of 5.0% (95% CI, 2.6-9.3) and 5.5% (95% CI, 3.0-10.0), respectively. The prevalence was 7.3% (95% CI, 5.3-10.0) for patients aged ≤ 60 years and increased to 13.7% (95% CI, 8.2-22.1) for those aged ≤45 years.
CONCLUSIONS
Approximately 1 in 21 patients with ACS has FH, and this increases to 1 in 7 among those ≤45 years. These results reinforce the importance of screening for FH in the ACS population.
Identifiants
pubmed: 31500889
pii: S0828-282X(19)30433-7
doi: 10.1016/j.cjca.2019.06.017
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1322-1331Subventions
Organisme : CIHR
ID : PJT162096
Pays : Canada
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.