Case-finding and genetic testing for familial hypercholesterolaemia in primary care.
OBJECTIVE: Familial hypercholesterolaemia (FH) is a common inherited disorder that remains mostly undetected in the general population. Through FH case-finding and direct access to genetic testing in primary care, this intervention study described the genetic and lipid profile of patients found at increased risk of FH and the outcomes in those with positive genetic test results.
METHODS: In 14 Central England general practices, a novel case-finding tool (Familial Hypercholetserolaemia Case Ascertainment Tool, FAMCAT1) was applied to the electronic health records of 86 219 patients with cholesterol readings (44.5% of total practices' population), identifying 3375 at increased risk of FH. Of these, a cohort of 336 consenting to completing Family History Questionnaire and detailed review of their clinical data, were offered FH genetic testing in primary care.
RESULTS: Genetic testing was completed by 283 patients, newly identifying 16 with genetically confirmed FH and 10 with variants of unknown significance. All 26 (9%) were recommended for referral and 19 attended specialist assessment. In a further 153 (54%) patients, the test suggested polygenic hypercholesterolaemia who were managed in primary care. Total cholesterol and low-density lipoprotein-cholesterol levels were higher in those patients with FH-causing variants than those with other genetic test results (p=0.010 and p=0.002).
CONCLUSION: Electronic case-finding and genetic testing in primary care could improve identification of FH; and the better targeting of patients for specialist assessment. A significant proportion of patients identified at risk of FH are likely to have polygenic hypercholesterolaemia. There needs to be a clearer management plan for these individuals in primary care.
TRIAL REGISTRATION NUMBER: NCT03934320.
|投稿者||Qureshi, Nadeem; Akyea, Ralph Kwame; Dutton, Brittany; Humphries, Steve E; Abdul Hamid, Hasidah; Condon, Laura; Weng, Stephen F; Kai, Joe|
|ジャーナル名||Heart (British Cardiac Society)|
|組織名||Centre for Academic Primary Care, School of Medicine, University of Nottingham,;Nottingham, UK email@example.com.;Nottingham, UK.;Centre for Cardiovascular Genetics, Institute of Cardiovascular Science,;University College London, London, UK.;Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi;MARA, Sungai Buloh, Malaysia.;Associate Director, Cardiovascular and Metabolism, Janssen Research &;Development, High Wycombe, UK.|