Familial hypercholesterolaemia and coronary risk factors among patients with angiogram-proven premature coronary artery disease in an Asian cohort

• DOI: 10.1371/journal.pone.0273896
• Publication Date: 2022-09-02T17:41:22Z
• Authors: Sukma Azureen Nazli; Yung-An Chua; Noor Alicezah Moh...; Zaliha Ismail; Ahmad Bakhtiar Md...; Khairul Shafiq Ib...; Sazzli Shahlan Kasim; Azhari Rosman; Hapizah Nawawi
• Keywords: Male; Coronary angiogram; Science; Endocrinology, Diabetes and Metabolism; Coronary angiography; Cardiology; Coronary Artery Disease; Coronary artery disease; Hyperlipoproteinemia Type II; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Health Sciences; Prevalence; Humans; Clinical Studies on Coronary Stents and Revascularization; Internal medicine; 2. Zero hunger; Q; R; Angiography; Cohort; Cholesterol, LDL; Middle Aged; 3. Good health; Coronary heart disease; Myocardial infarction; Cholesterol-lowering Treatment; Atherosclerotic Cardiovascular Risk; Hypertension; Medicine; Surgery; Metabolic Syndrome and Cardiovascular Disease; Cohort study; Research Article

Background Familial hypercholesterolaemia (FH) patients have elevated levels of low-density lipoprotein cholesterol, rendering them at high risk of premature coronary artery disease (PCAD). However, the FH prevalence among angiogram-proven PCAD (AP-PCAD) patients and their status of coronary risk factors (CRFs) have not been reported in the Asian population.

Objectives This study aimed to (1) determine the prevalence of clinically diagnosed FH among AP-PCAD patients, (2) compare CRFs between AP-PCAD patients with control groups, and (3) identify the independent predictors of PCAD.

Methods AP-PCAD patients and FH patients without PCAD were recruited from Cardiology and Specialist Lipid Clinics. Subjects were divided into AP-PCAD with FH (G1), AP-PCAD without FH (G2), FH without PCAD (G3) and normal controls (G4). Medical records were collected from the clinic database and standardised questionnaires. FH was clinically diagnosed using Dutch Lipid Clinic Network Criteria.

Results A total of 572 subjects were recruited (males:86.4%; mean±SD age: 55.6±8.5years). The prevalence of Definite, Potential and All FH among AP-PCAD patients were 6%(19/319), 16% (51/319) and 45.5% (145/319) respectively. G1 had higher central obesity, family history of PCAD and family history of hypercholesterolaemia compared to other groups. Among all subjects, diabetes [OR(95% CI): 4.7(2.9,7.7)], hypertension [OR(95% CI): 14.1(7.8,25.6)], FH [OR(95% CI): 2.9(1.5,5.5)] and Potential (Definite and Probable) FH [OR(95% CI): 4.5(2.1,9.6)] were independent predictors for PCAD. Among FH patients, family history of PCAD [OR(95% CI): 3.0(1.4,6.3)] and Definite FH [OR(95% CI): 7.1(1.9,27.4)] were independent predictors for PCAD.

Conclusion Potential FH is common among AP-PCAD patients and contributes greatly to the AP-PCAD. FH-PCAD subjects have greater proportions of various risk factors compared to other groups. Presence of FH, diabetes, hypertension, obesity and family history of PCAD are independent predictors of PCAD. FH with PCAD is in very-high-risk category, hence, early management of modifiable CRFs in these patients are warranted.