Estimated Prevalence of Heterozygous Familial Hypercholesterolemia in Patients With Acute Coronary Syndrome
Estimated Prevalence of Heterozygous Familial Hypercholesterolemia in Patients With Acute Coronary Syndrome
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DOI：
10.1536/ihj.16-188
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发表时间：
2017-01-01
影响因子：
1.5
通讯作者：
Daida, Hiroyuki
中科院分区：
文献类型：
--
作者：
Ohmura, Hirotoshi;Fukushima, Yoshifumi;Daida, Hiroyuki
杂合子型家族性高胆固醇血症（FH）是早发冠心病（CAD）的高危人群。然而，大多数FH患者未被诊断，在大多数国家，患病率可能被低估。在日本，FH对CAD发展的可能贡献可能更高，因为一般人群中CAD的发病率较低。我们通过测量急性冠状动脉综合征（ACS）患者的跟腱厚度（ATT）来估计杂合子FH的患病率。根据日本动脉粥样硬化学会提出的诊断标准定义杂合子FH。由于缺失ATT数据或血浆甘油三酯水平≥ 4.5 mmol/L排除63例患者后，296例患者有资格入选研究。ATT ≥ 9 mm的患者数量为53例（17.9%）。与ATT小于9 mm的患者相比，他们明显更年轻，LDL胆固醇水平明显更高。杂合子FI-1的患病率为5.7%（1/17.5），在60岁以下的年轻患者中更为突出（7.8%）。在NIT为9 mm或更大的患者中，约1/3.5符合杂合子FH的标准。我们证明了在日本ACS患者中，特别是年龄小于60岁的年轻患者中，通过放射学测量ATT的有用性和杂合子FH的高患病率。
Heterozygous familial hypercholesterolemia (FH) represents a strong risk for development of premature coronary artery disease (CAD). However, the majority of patients with FH are undiagnosed and the prevalence likely represents an underestimate in most countries. In Japan, the possible contribution of FH to the development of CAD may be higher because of the low incidence of CAD among the general population. We estimated the prevalence of heterozygous FH by measuring Achilles tendon thickness (ATT) in patients with acute coronary syndrome (ACS).A total of 359 patients suffering from ACS were enrolled in this multicenter registration study. Heterozygous FH was defined according to the diagnostic criteria proposed by the Japan Atherosclerosis Society. After excluding 63 patients because of missing ATT data or plasma triglyceride levels that were 4.5 mmol/L or more, 296 patients were eligible for inclusion in the study. The number of patients with ATT of 9 mm or more was 53 (17.9%). They were significantly younger and had significantly higher LDL cholesterol levels than patients with an ATT less than 9 mm. The prevalence of heterozygous FI-1 was 5.7% (1/17.5) and more prominent in younger patients who were less than 60 years old (7.8%). In patients with NIT of 9 mm or more, approximately 1 in 3.5 fulfilled the criteria for heterozygous FH.We demonstrated the usefulness of measuring ATT by radiography and the high prevalence of heterozygous FH in patients with ACS in Japan, especially in younger patients who were less than 60 years old.