Comparison of Equations for the Calculation of LDL-Cholesterol in Familial Hypercholesterolemia: Data from Iranian Registry.

OBJECTIVE: Low-density lipoprotein cholesterol is the mainstay of diagnosis, treatment, and follow-up of patients with familial hypercholesterolemia, the most prevalent autosomal domi- nant disorder among humans. Since the reference measurement method (ultracentrifugation) is time-consuming and expensive, many formulas emerged to calculate low-density lipopro- tein cholesterol levels and are commonly used in laboratories. METHODS: To compare the performance of 3 low-density lipoprotein cholesterol calcula- tion equations with a direct method (enzymatic photometric assay), the lipid profiles of 1148 patients of the registry of familial hypercholesterolemia in Iran were analyzed retrospec- tively, 270 of which had a possible or definite familial hypercholesterolemia diagnosis according to Dutch criteria. While measured using the direct method, we calculated the low-density lipoprotein cholesterol levels using the Friedewald, Chen, and Anandaraja formulas. RESULTS: Our results showed that all 3 formulas are highly correlated with the direct method, and the Chen formula showed the highest intra-class correlation coefficient among all (0.954 among all patients with hypercholesterolemia and 0.947 among the familial hyper- cholesterolemia population). In addition, the Chen formula was the most sensitive, and the Friedewald formula was the most specific formula using a low-density lipoprotein cholesterol cut-off of 100 in familial hypercholesterolemia patients. CONCLUSION: Our findings encourage applying the Chen formula in addition to the Friedewald formula to make better clinical decisions for familial hypercholesterolemia patients.

Establishment of Health Clinics as Mass Screening and Referral Systems for Chronic Non-communicable Diseases in Primary Health Care.

BACKGROUND: This study aimed to establish a comprehensive screening and referral system for chronic non-communicable diseases (CNCD) in the routine primary health care, and to determine the prevalence of diabetes, pre-diabetes, metabolic syndrome, and dyslipidemia in adult population invited by public announcement to the Health clinics in Isfahan, Iran. METHODS: This survey was conducted from March 2010, and the current paper presents data obtained until November 2011. To provide health services for prevention and control of CNCDs, with priority of type2 diabetes mellitus, Health clinics were established in different parts of Isfahan city with a population of approximately 2,100,000 in Iran. The general populations aged 30 years and above were invited to the Health clinics by public announcement. RESULTS: A total of 198972 participants were screened. The mean age of participants was 47.8 years (48.5 men, 47.3 women), with a range of 1 to 95 years old and standard deviation of 12.3 years (12.7 men, 12.1 women). Overall, 22% of participants had impaired fasting glucose, 25% had hypercholesterolemia, 31% had hypertriglyceridemia, and 20% had metabolic syndrome. CONCLUSION: The high prevalence of dysglycemia and diabetes in our survey may serve as confirmatory evidence about the importance of mass screening and early diagnosis of CNCDs' risk factors. Our model of establishing Health clinics, as a comprehensive referral system in the routine primary health care can be adopted by Middle Eastern countries, where CNCDs notably diabetes are an emerging health problem.