Mariko Harada-Shiba1, Junya Ako2, Hidenori Arai3, Atsushi Hirayama4, Yoshitaka Murakami5, Atsushi Nohara6, Asuka Ozaki7, Kiyoko Uno8, Masato Nakamura9. 1. Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. Electronic address: mshiba@ncvc.go.jp. 2. Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan. Electronic address: jako@kitasato-u.ac.jp. 3. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan. Electronic address: harai@ncgg.go.jp. 4. Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan. Electronic address: hirayama.atsushi@nihon-u.ac.jp. 5. Department of Medical Statistics, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan. Electronic address: yoshitaka.murakami@med.toho-u.ac.jp. 6. Department of Cardiology, Kanazawa University of Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. Electronic address: a-nohara@med.kanazawa-u.ac.jp. 7. Sanofi, Tokyo Opera City Tower, 3-20-2 Nishi Shinjuku, Tokyo, 163-1488, Japan. Electronic address: Asuka.Ozaki@sanofi.com. 8. Sanofi, Tokyo Opera City Tower, 3-20-2 Nishi Shinjuku, Tokyo, 163-1488, Japan. Electronic address: Kiyoko.Uno@sanofi.com. 9. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi Meguro, Tokyo, 153-8515, Japan. Electronic address: masato@oha.toho-u.ac.jp.
Abstract
BACKGROUND AND AIMS: Prevalence of familial hypercholesterolemia (FH), a common genetic disorder with a high risk for coronary artery disease (CAD), is high among CAD patients; however, data on FH prevalence among acute coronary syndrome (ACS) patients are limited. EXPLORE-J is the largest registry to diagnose FH among Japanese ACS patients using the 2012 Japan Atherosclerosis Society guidelines. METHODS: This prospective study consecutively recruited patients between April 2015 and August 2016 at 59 sites. Low-density lipoprotein cholesterol (LDL-C) levels, family history of premature CAD, presence of tendon xanthomas, and Achilles tendon radiograms were recorded at baseline. The prevalence rate of FH in patients with ACS was estimated with 95% CI. RESULTS: Of 1944 analyzed patients (mean age, 66.0 years; men, 80.3%), 52 (2.7% [95% CI: 2.0-3.5]) had FH. Thirty-one (1.6%) had LDL-C ≥180 mg/dL and Achilles tendon thickness (ATT) ≥9 mm, 8 (0.4%) had LDL-C ≥180 mg/dL and family history of premature CAD, 10 (0.5%) had ATT ≥9 mm and family history of premature CAD, and 3 (0.2%) met all the criteria. FH patients were younger than those without FH (59.5 [12.5] vs. 66.2 [12.1] years; p < 0.001). More patients with premature ACS (men, <55 years; women, <65 years) than without (4.7% [95% CI: 2.9-7.2] vs. 2.1% [1.4-3.0]) had FH. CONCLUSIONS: FH prevalence is at least five-fold higher in ACS patients than in the general population, especially in patients with premature ACS onset and ATT ≥9 mm. FH screening in ACS patients is therefore clinically important and critical.
BACKGROUND AND AIMS: Prevalence of familial hypercholesterolemia (FH), a common genetic disorder with a high risk for coronary artery disease (CAD), is high among CAD patients; however, data on FH prevalence among acute coronary syndrome (ACS) patients are limited. EXPLORE-J is the largest registry to diagnose FH among Japanese ACS patients using the 2012 Japan Atherosclerosis Society guidelines. METHODS: This prospective study consecutively recruited patients between April 2015 and August 2016 at 59 sites. Low-density lipoprotein cholesterol (LDL-C) levels, family history of premature CAD, presence of tendon xanthomas, and Achilles tendon radiograms were recorded at baseline. The prevalence rate of FH in patients with ACS was estimated with 95% CI. RESULTS: Of 1944 analyzed patients (mean age, 66.0 years; men, 80.3%), 52 (2.7% [95% CI: 2.0-3.5]) had FH. Thirty-one (1.6%) had LDL-C ≥180 mg/dL and Achilles tendon thickness (ATT) ≥9 mm, 8 (0.4%) had LDL-C ≥180 mg/dL and family history of premature CAD, 10 (0.5%) had ATT ≥9 mm and family history of premature CAD, and 3 (0.2%) met all the criteria. FHpatients were younger than those without FH (59.5 [12.5] vs. 66.2 [12.1] years; p < 0.001). More patients with premature ACS (men, <55 years; women, <65 years) than without (4.7% [95% CI: 2.9-7.2] vs. 2.1% [1.4-3.0]) had FH. CONCLUSIONS:FH prevalence is at least five-fold higher in ACS patients than in the general population, especially in patients with premature ACS onset and ATT ≥9 mm. FH screening in ACS patients is therefore clinically important and critical.