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Familial hypercholesterolemia in primary care in Germany. Diabetes and cardiovascular risk evaluation: Targets and
Nina Schmidt1, Burkhard Schmidt2, Alexander Dressel1
1D A CH-Gesellschaft Prävention von Herz-Kreislauferkrankungen e.V., Schulterblatt 120, 20357 Hamburg, Germany.
Insights
Familial hypercholesterolemia (FH) is more common in Germany than previously thought. Early diagnosis and treatment are crucial for reducing cardiovascular disease risk in affected individuals.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Familial hypercholesterolemia (FH) is an inherited lipid metabolism disorder.
- It leads to elevated low-density lipoproteins (LDL) and increased cardiovascular disease (CVD) risk.
- Early diagnosis and treatment significantly reduce CVD risk.
Purpose of the Study:
- To determine the prevalence of FH in Germany.
- To address the lack of reliable FH prevalence data in the German population.
- To analyze FH prevalence in a primary care setting.
Main Methods:
- Utilized data from 4722 participants in the DETECT study.
- Assessed FH prevalence using Dutch Lipid Clinics Network (DLCN) and US-MEDPED criteria.
- Stratified analysis by gender and age, with statistical tests including Chi2 and ANOVA.
Main Results:
- Prevalence rates of 1:278 (DLCN) and 1:295 (US-MEDPED) were found.
- Diagnostic criteria identified different patient groups.
- Lower LDL-C in women under 50 may lead to under-diagnosis in this demographic.
Conclusions:
- FH is more prevalent in Germany than anticipated.
- Current clinical diagnostic algorithms may lack concordance.
- Further research is needed to optimize FH diagnosis in diverse populations.
Background And Aims:
Familial hypercholesterolemia (FH) is an inherited disorder of lipoprotein metabolism characterised by impaired removal of low-density lipoproteins (LDL) from the circulation, which leads to an increased risk of cardiovascular disease (CVD). This risk can be significantly lowered by early diagnosis and treatment. In Germany, reliable estimates of the prevalence of FH are lacking. We therefore examined the prevalence rate of FH in Germany in a primary care based cohort.
Method:
We utilized records of 4722 participants in the DETECT study, in whom complete data on blood lipids and medical history were available. Prevalence rates were assessed using the Dutch Lipid Clinics Network (DLCN) and the US-MEDPED criteria. We stratified for gender and age. Group differences were analyzed using Chi2 and ANOVA tests.
Results:
Using the DLCN (probable or definite FH) and the US.MEDPED criteria yielded prevalence rates of 1:278 and 1:295, respectively. The established diagnostic scores used in this analysis identify different patients. In women below 50 years of age, the LDL-C concentration is lower than in men, leading to the possibility of under-diagnosing FH in this group because women under the age of 50 are less likely to reach a higher DLCN-Score.
Conclusions:
FH has a higher than expected prevalence in Germany. Clinical diagnostic algorithms may not be concordant.
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