Prevalence, management, and outcomes of familial hypercholesterolemia in patients with acute coronary syndromes in the Arabian Gulf

Khalid Al-Rasadi, Ibrahim Al-Zakwani, Alawi A. Alsheikh-Ali, Wael Almahmeed, Wafa Rashed, Mustafa Ridha, Raul D. Santos, Mohammad Zubaid

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Abstract

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 (N = 3224) hospitalized with ACS were studied. FH was diagnosed using the Dutch Lipid Clinic Network criteria. A composite endpoint of nonfatal myocardial infarction, stroke, transient ischemic attack, 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 ACS patients was 3.7% (n = 119), 28% (n = 911), and 68% (n = 2194), respectively. Overall, 54% (n = 1730) of patients had diabetes, whereas 24% (n = 783) 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.

Original languageEnglish
JournalJournal of Clinical Lipidology
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Keywords

  • Acute coronary syndrome
  • Arabs
  • Cardiovascular abnormality
  • Diabetes
  • Hypercholesterolemia
  • Middle East

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

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