High Lipoprotein(a) May Explain One-Quarter of Clinical Familial Hypercholesterolemia Diagnoses in Danish Lipid Clinics.

CONTEXT: Cholesterol carried in lipoprotein(a) adds to measured low-density lipoprotein cholesterol (LDL-C) and may therefore drive some diagnoses of clinical familial hypercholesterolemia (FH). OBJECTIVE: We investigated plasma lipoprotein(a) in individuals referred to Danish lipid clinics and evaluated the effect of plasma lipoprotein(a) on a diagnosis of FH. METHODS: Individuals referred to 15 Danish lipid clinics who were suspected of having FH according to nationwide referral criteria were recruited between September 1, 2020 and November 30, 2021. All individuals were classified according to the Dutch Lipid Clinical Network criteria for FH before and after LDL-C was adjusted for 30% cholesterol content in lipoprotein(a). We calculated the fraction of individuals fulfilling a clinical diagnosis of FH partly due to elevated lipoprotein(a). RESULTS: We included a total of 1166 individuals for analysis, of whom 206 fulfilled a clinical diagnosis of FH. Median lipoprotein(a) was 15 mg/dL (29 nmol/L) in those referred and 28% had lipoprotein(a) greater than or equal to 50 mg/dL (105 nmol/L), while 2% had levels greater than or equal to 180 mg/dL (389 nmol/L). We found that in 27% (55/206) of those fulfilling a clinical diagnosis of FH, this was partly due to high lipoprotein(a). CONCLUSION: Elevated lipoprotein(a) was common in individuals referred to Danish lipid clinics and in one-quarter of individuals who fulfilled a clinical diagnosis of FH, this was partly due to elevated lipoprotein(a). These findings support the notion that the LPA gene should be considered an important causative gene in patients with clinical FH and further support the importance of measuring lipoprotein(a) when diagnosing FH as well as for stratification of cardiovascular risk.

Genetic testing increases the likelihood of a diagnosis of familial hypercholesterolaemia among people referred to lipid clinics: Danish national study.

BACKGROUND AND AIMS: It is unclear to what extent genetic testing improves the ability to diagnose familial hypercholesterolaemia (FH). We investigated the percentage with FH among individuals referred to Danish lipid clinics, and evaluated the impact of genetic testing for a diagnosis of FH. METHODS: From September 2020 through November 2021, all patients referred for possible FH to one of the 15 Danish lipid clinics were invited for study participation and >97% (n = 1488) accepted. The Dutch Lipid Clinical Network criteria were used to diagnose clinical FH. The decision of genetic testing for FH was based on local practice. RESULTS: A total of 1243 individuals were referred, of whom 25.9% were diagnosed with genetic and/or clinical FH. In individuals genetically tested (n = 705), 21.7% had probable or definite clinical FH before testing, a percentage that increased to 36.9% after genetic testing. In individuals with unlikely and possible FH before genetic testing, 24.4% and 19.0%, respectively, had a causative pathogenic variant. CONCLUSIONS: In a Danish nationwide study, genetic testing increased a diagnosis of FH from 22% to 37% in patients referred with hypercholesterolaemia suspected of having FH. Importantly, approximately 20% with unlikely or possible FH, who without genetic testing would not have been considered having FH (and family screening would not have been undertaken), had a pathogenic FH variant. We therefore recommend a more widespread use of genetic testing for evaluation of a possible FH diagnosis and potential cascade screening.

[Successful treatment of supraventricular tachycardia with a modified Valsalva manoeuvre]. / Vellykket behandling af supraventrikulær takykardi med modificeret Valsalvas manøvre.

Supraventricular tachycardia (SVT) is a frequent challenge in medical emergency units. Adenosine, the drug of choice, may cause severe discomfort. The Danish Society of Cardiology's National Treatment Guidelines for SVT recommend first aid treatment with ''vagus stimulation such as carotid massage and Valsalva manoeuvre''. A disadvantage of the Valsalva manoeuvre is that only 5-20% of the patients convert to sinus rhythm. We describe a case story of a patient, who was successfully treated with ''modified Valsalva'' as described in a recently published study wherein 43% of the patients converted to sinus rhythm compared to 17% in the control group.

Psychological job demands increase the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men.

AIMS: To test the relationship between job strain and the incidence of ischaemic heart disease (IHD) prospectively in the Danish working population. METHODS AND RESULTS: In 1986, a clinical examination was undertaken of 659 men, all employed and without known IHD, together with a questionnaire-based evaluation of living conditions and psychosocial factors at work, including items identified in the job strain model. This study was part of the World Health Organization-initiated MONICA II study. In the job strain model, job strain is defined as the combination of high psychological demands and a low degree of control in the work situation. An objective classification of the components in the job strain model was made by imputation by utilizing the participants' job title and the principles guiding the payment of their salaries/wages. In addition, a questionnaire-based subjective classification was undertaken. All participants were followed until the end of 1999 with regard to hospitalization and death as a result of IHD. Stepwise analyses were made, adjusting for age, social class, social network and established behavioural and physiological coronary risk factors. Self-reported job strain was significantly associated with IHD independently of standard coronary risk factors. Of the two components in the job strain model only high demands contributed significantly to this result. The study did not support the job strain hypothesis when an imputed, objective classification of the components in the job strain model was applied. This is in accordance with the majority of other studies in this area. An unexpected finding was that the incidence of IHD was highest among employers and managers. CONCLUSION: High psychological demands at work are a risk factor for IHD, a fact that should affect the primary and secondary prevention of IHD.

[Is use of surgical caps and masks obsolete during percutaneous heart catheterization?]. / Er brug af kirurgisk hat og maske obsolet ved perkutan hjertekateterisation?

INTRODUCTION: Despite the lack of scientific evidence, surgical caps and masks are worn routinely by many physicians and nurses in the catheterisation laboratories to avoid local and generalised infections. When we changed our practice, we performed a randomised study to assure the quality of our routine. MATERIAL AND METHODS: All patients undergoing left- or right-sided cardiac catheterisation were randomly allocated to our five laboratories. About two months after the procedure, the patients were sent a questionnaire concerning signs and symptoms of possible inflammation or infection after the procedure. RESULTS: Of 1,034 patients, 855 (82.7%) responded to the questionnaire. Although 25 patients in the caps and mask group vs 19 patients in the other group (6.1% vs 4.3%, ns) had complaints from the procedural access site in the groin, none of these could be ascribed to definite infection. DISCUSSION: The use of caps and masks during percutaneous cardiac catheterisation procedures is based on the concept that the infection rate of patients is reduced. The size of the catheter used, procedure time, and the use of caps and masks by both the surgeon and the assisting staff are discussed. CONCLUSION: The routine use of caps and masks does not seem to have that much beneficial impact on the occurrence of procedure-related inflammations or infections in the cardiac catheterisation laboratory.