Prevalence, management, and outcomes of familial hypercholesterolemia in patients with acute coronary syndromes in the Arabian Gulf
Alsheikh-Ali, Alawi A.
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Background: Information on the epidemiology of familial hypercholesterolemia (FH) in the Arabian Gulf region, which has an elevated rate of consanguinity and type II diabetes, is scarce. Objectives: To assess the prevalence of FH, its management, and impact on atherosclerotic cardiovascular disease (ASCVD) outcomes in a multicenter cohort of Arabian Gulf patients with acute coronary syndrome (ACS). Methods: Patients (N53224) hospitalized with ACS were studied. FH was diagnosed using the DutchLipid Clinic Network criteria. A composite endpoint of nonfatal myocardial infarction, stroke, transient is chemicattack, and mortality between the ‘‘probable/definite’’ and the ‘‘unlikely’’ FH patients was assessed after 1 year. Analyses were performed using univariate and multivariate statistical techniques. Results: At admission, the proportion of ‘‘probable/definite’’, ‘‘possible’’, and ‘‘unlikely’’ FH in ACSpatients was 3.7% (n5119), 28% (n5911), and 68% (n52194), respectively. Overall, 54% (n51730) of patients had diabetes, whereas 24% (n5783) were current smokers. The ‘‘probable/definite’’ FH group was younger (50 vs 63 years;P,.001), had a greater prevalence of early coronary disease (38% vs 8.8%;P,.001), and previous statin use (87% vs 57%;P,.001) when compared with the ‘‘unlikely’’ FH group.After 1 year, the ‘‘probable/definite’’ FH cohort had worse lipid control (13% vs 23%;P,.001) and presented with a greater association with the composite ASCVD endpoint when compared with the “unlikely” FH group (odds ratio: 1.85; 95% confidence interval: 1.01–3.38; P = .047) after multivariable adjustment. Conclusions: In Arabian Gulf citizens, FH was common in ACS patients, was undertreated, and was associated with a worse 1-year prognosis.