P6265Prevalence of clinical features of familial hypercholesterolemia in patients admitted for an acute coronary syndrome

Abstract

Background: Familiar hypercholesterolemia (FH) is genetic disease that leads to increased serum low-density lipoprotein cholesterol (LDLc) and premature acute coronary syndromes (ACS). Definite diagnosis of FH is based on genetic test but clinical assessment, by the Dutch Lipid Clinic Network (DLCN) criteria, is very accessible. The objective of our study was describing the prevalence and prognosis of FH, assessed by clinical criteria, in patients admitted for an ACS. Methods: We designed a multicentre, observational, prospective and nationwide registry of patients admitted for an ACS in 30 hospitals from Spain. The DLCN criteria were analysed in all patients and they were classified in: unlikely-FH (0-2 criteria), possible-FH (3-5 criteria), probable-FH (6-7 criteria) or definite-FH (>7 criteria). Premature ACS was defined if age at admission was <55 in men or <65 in women. Results: We included 867 patients, 72.3% males, mean body mass index 28.4 (4.4) kg/m2, 20.6% diabetics and 52.6% STEMI. Unlikely-FH accounted for 84.2% of the cohort; the prevalence of possible HF was 14.5%, probable-HF 1.1% and only 1 patient was diagnosed of definite-FH. We created a group of patients of possible/probable FH hat included 137 patients (15.8%). The prevalence of premature ACS was 10.1% but in patients with premature ACS the prevalence of possible/ probable FH was 23.9%. Patients with possible/probable FH had lower mean age (57.6±10.4 vs. 61.9±11.3; p<0.01) but higher prevalence of peripheral arterial disease (8.0% vs. 4.4%; p=0.04). As expected, they had statistically higher previous diagnosis of hypercholesterolemia (65.7% vs. 43.8%), higher LDLc levels (160.5±43.1 vs. 105.2±102.2) and statins treatments before admission (35.8% vs. 26.4%). They also had lower GRACE score (111.0±2.53 vs. 119.8±25.8) but higher number of coronary lesions (1.6±0.1 vs. 1.4±0.03). Revascularization was performed in 82.4% of the patients and no differences were found between patients with or without possible/probable FH (87.6% vs. 81.4%; p=0.08). Patients with possible/probable HF received more frequently statins at discharge (96.4% vs. 84.8%; p<0.01). Conclusion: 15.8% of patients with ACS have possible/probable FH and the prevalence increases up to 23% in patients with premature ACS. The postdischarge follow-up of this on-going registry will provide actual prognosis of patients with clinical diagnosis of possible and probable FH. (Figure Presented).