title: Cardiovascular risk stratification in familial hypercholesterolaemia.
abstract: Familial hypercholesterolaemia (FH) is a common autosomal-dominant disorder in most European countries. Patients with FH are characterised by a raised level of low-density lipoprotein cholesterol and a high risk of premature coronary heart disease (CHD). Currently there is no consensus regarding the clinical utility to predict future coronary events or testing for the presence of subclinical atherosclerotic disease in asymptomatic patients with FH. Family screening of patients with FH as recommended by the UK National Institute of Health and Care Excellence guideline would result in finding many young individuals with a diagnosis of FH who are clinically asymptomatic. The traditional CHD risk scores, that is, the Framingham score, are insufficient in risk prediction in this group of young individuals. In addition, a better understanding of the genetic aetiology of the FH phenotype and CHD risk in monogenic FH and polygenic hypercholesterolaemia is needed. Non-invasive imaging methods such as carotid intima-media thickness measurement might produce more reliable information in finding high-risk patients with FH. The potential market authorisation of novel therapeutic agents such as PCSK9 monoclonal inhibitors makes it essential to have a better screening programme to prioritise the candidates for treatment with the most severe form of FH and at higher risk of coronary events. The utility of new imaging techniques and new cardiovascular biomarkers remains to be determined in prospective trials.
authors.affiliation: Department of Clinical Biochemistry, Royal Free Hospital, London, UK Department of Cardiology, Royal Free Hospital and Institute of Cardiovascular Science, University College London, London, UK Cardiovascular Genetic Centre, University College London, London, UK.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Sharifi
authors.affiliation: Department of Cardiology, Royal Free Hospital and Institute of Cardiovascular Science, University College London, London, UK.
authors.forename: Roby D
authors.initials: RD
authors.lastname: Rakhit
authors.affiliation: Cardiovascular Genetic Centre, University College London, London, UK.
authors.forename: Steve E
authors.initials: SE
authors.lastname: Humphries
authors.affiliation: Department of Clinical Biochemistry, Royal Free Hospital, London, UK.
authors.forename: Devaki
authors.initials: D
authors.lastname: Nair
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000235:genetics / Q000628:therapy; D020022:Genetic Predisposition to Disease; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications* / Q000235:genetics; D008279:Magnetic Resonance Imaging; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014057:Tomography, X-Ray Computed