ABSTRACT
The burden caused by familial hypercholesterolemia (FH) varies among countries and ethnic groups. The prevalence and characteristics of FH in Latin American (LA) countries is largely unknown. We present a systematic review (following the PRISMA statement) of FH in LA countries. The epidemiology, genetics, screening, management, and unique challenges encountered in these countries are discussed. Published reports discussing FH in Hispanic or LA groups was considered for analysis. Thirty studies were included representing 10 countries. The bulk of the data was generated in Brazil and Mexico. Few countries have registries and there was little commonality in FH mutations between LA countries. LDL receptor mutations predominate; APOB and PCSK9 mutations are rare. No mutation was found in an FH gene in nearly 50% of cases. In addition, some country-specific mutations have been reported. Scant information exists regarding models of care, cascade screening, cost, treatment effectiveness, morbidity, and mortality. In conclusion, FH is largely underdiagnosed and undertreated in the LA region. The genetic admixture with indigenous populations, producing mestizo's groups, may influence the mutational findings in Latin America. Potential opportunities to close gaps in knowledge and health care are identified.
Subject(s)
Hyperlipoproteinemia Type II/epidemiology , Apolipoproteins B/genetics , Humans , Hyperlipoproteinemia Type II/genetics , Hyperlipoproteinemia Type II/therapy , Latin America/epidemiology , Mutation , Receptors, LDL/genetics , Risk FactorsABSTRACT
La hipercolesterolemia familiar heterocigota (HFHe) es una enfermedad genética, común, autosómica dominante, causante de enfermedad cardíaca coronaria precoz. Si la HFHe es detectada y tratada en forma temprana, aquellos individuos afectados llegan a tener una expectativa de vida equivalente a las personas no afectadas. Diferentes estrategias existen para realizar una correcta identificación de los casos con HFHe; criterios fenotípicos, basados en niveles elevados de colesterol de lipoproteínas de baja densidad (C-LDL), estigmas clínicos (arco corneal, xantomas), sumados a antecedentes familiares de elevación del C-LDL y eventos cardiovasculares precoces son clásicamente utilizados en la práctica diaria. Por otro lado, existe la posibilidad de hacer diagnóstico genético de la HFHe y complementarlo con los aspectos y criterios fenotípicos. El desafío, una vez identificado el caso de HFHe, es implementar una estrategia de detección familiar, ya que por las características de heredabilidad mencionadas de la enfermedad, existe un cincuenta por ciento de probabilidad que un familiar directo padezca la enfermedad. El objetivo principal de esta revisión es presentar y discutir las diferentes estrategias de identificación y detección de pacientes con HFHe.
Heterozygous familial hypercholesterolemia (HeFH) is a common autosomal dominant genetic disease, which causes premature coronary heart disease. If HeFH detected and treated early, those affected individuals have a life expectation equivalent to unaffected individuals. Different strategies exist to make a correct identification of cases with HeFH; phenotypic criteria, based on elevated levels of low density lipoprotein cholesterol (LDL-C), clinical stigmata (corneal arcus, xanthomas), together with a family history of elevated LDL-C and early cardiovascular events are conventionally used in daily practice. On the other hand there is the possibility of genetic diagnosis of HeFH and this is complemented with aspects and phenotypic criteria. Once identified HeFH case, the challenge is to implement a strategy of family screening, since the characteristics mentioned heritability of the disease, there is a fifty percent chance that a direct family member has the disease. The primary objective of this review is to present and discuss different strategies for the identification and detection of patients with HeFH.
A hipercolesterolemia familiar heterozigótica (HFHe) é uma doença genética comum, autossômica dominante, que causa a doença arterial coronariana precoce. Se HFHe é detectada e tratada precocemente, aqueles indivíduos afetados têm uma expectativa de vida equivalente a indivíduos não afetados. Existem diferentes estratégias para a identificação correta de casos com HFHe; critérios fenotípicos, baseados em níveis elevados de colesterol de lipoproteína de baixa densidade (C-LDL), estigmas clínicos (arco corneal, xantomas), juntamente com uma história familiar de elevados níveis de C-LDL e os eventos cardiovasculares precoces são convencionalmente utilizados na prática diária. Por outro lado, existe a possibilidade de realizar um diagnóstico genético da HFHe e esta é complementado com aspectos e critérios fenotípicos. Uma vez identificado o caso de HFHe, o desafio é implementar uma estratégia de triagem familiar, de acordo com as características mencionadas da hereditariedade da doença, existe uma chance de cinquenta por cento que um membro direto da família tem a doença. O principal objetivo desta revisão é apresentar e discutir estratégias diferentes para a identificação e detecção dos pacientes com HFHe.