Clinical features of familial hypercholesterolemia in Korea: Predictors of pathogenic mutations and coronary artery disease - A study supported by the Korean Society of Lipidology and Atherosclerosis

Dong Geum Shin, Soo Min Han, Doo Il Kim, Moo Yong Rhee, Byoung Kwon Lee, Young Keun Ahn, Byung Ryul Cho, Jeong Taek Woo, Seung Ho Hur, Jin Ok Jeong, Yangsoo Jang, Ji Hyun Lee, Sang Hak Lee

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Abstract

Background: Proper screening and diagnosis of familial hypercholesterolemia (FH) is of critical importance for cardiovascular prevention. However, the clinical diagnosis of FH remains difficult partly because its phenotype can vary between different ethnicities. The aim of this study was to determine the clinical features and the best diagnostic approach in Korean FH patients. The predictors of putative pathogenic mutations and coronary artery disease (CAD) were also identified. Methods and Results: Ninety-seven patients with low-density lipoprotein-cholesterol >190 mg/dL and xanthoma or FH-compatible family history were included. Putative pathogenic mutations in LDLR, APOB, or PCSK9 genes were identified in 32% of the enrolled patients. The subjects were classified according to four sets of clinical criteria (Simon Broome, Dutch, MEDPED, Japanese). The mutation rates in definite type FH of Simon Broome or Dutch criteria were 35%-37% and lower in our patients than in those of other countries. The mutation detection rate by MEDPED criteria was 67%-75% and higher than those based on other criteria. The best low-density lipoprotein-cholesterol (LDL-C) threshold for predicting mutations was 225 mg/dL. LDL-C was found to be the only independent predictor of mutation carriers, while hypertension and low high-density lipoprotein-cholesterol were predictive of CAD. Conclusions: The conventional clinical criteria showed limited mutation detection power and low specificities in Korean FH patients, in whom the best LDL-C threshold for putative mutation was 225 mg/dL. Traditional cardiovascular risk factors were also significantly associated with CAD risk in this population.

Original languageEnglish
Pages (from-to)53-58
Number of pages6
JournalAtherosclerosis
Volume243
Issue number1
DOIs
Publication statusPublished - 2015 Nov 1

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Hyperlipoproteinemia Type II
Korea
Coronary Artery Disease
Atherosclerosis
LDL Cholesterol
Mutation
Mutation Rate
Xanthomatosis
HDL Cholesterol
Hypertension
Phenotype
Population
Genes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Shin, Dong Geum ; Han, Soo Min ; Kim, Doo Il ; Rhee, Moo Yong ; Lee, Byoung Kwon ; Ahn, Young Keun ; Cho, Byung Ryul ; Woo, Jeong Taek ; Hur, Seung Ho ; Jeong, Jin Ok ; Jang, Yangsoo ; Lee, Ji Hyun ; Lee, Sang Hak. / Clinical features of familial hypercholesterolemia in Korea : Predictors of pathogenic mutations and coronary artery disease - A study supported by the Korean Society of Lipidology and Atherosclerosis. In: Atherosclerosis. 2015 ; Vol. 243, No. 1. pp. 53-58.
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abstract = "Background: Proper screening and diagnosis of familial hypercholesterolemia (FH) is of critical importance for cardiovascular prevention. However, the clinical diagnosis of FH remains difficult partly because its phenotype can vary between different ethnicities. The aim of this study was to determine the clinical features and the best diagnostic approach in Korean FH patients. The predictors of putative pathogenic mutations and coronary artery disease (CAD) were also identified. Methods and Results: Ninety-seven patients with low-density lipoprotein-cholesterol >190 mg/dL and xanthoma or FH-compatible family history were included. Putative pathogenic mutations in LDLR, APOB, or PCSK9 genes were identified in 32{\%} of the enrolled patients. The subjects were classified according to four sets of clinical criteria (Simon Broome, Dutch, MEDPED, Japanese). The mutation rates in definite type FH of Simon Broome or Dutch criteria were 35{\%}-37{\%} and lower in our patients than in those of other countries. The mutation detection rate by MEDPED criteria was 67{\%}-75{\%} and higher than those based on other criteria. The best low-density lipoprotein-cholesterol (LDL-C) threshold for predicting mutations was 225 mg/dL. LDL-C was found to be the only independent predictor of mutation carriers, while hypertension and low high-density lipoprotein-cholesterol were predictive of CAD. Conclusions: The conventional clinical criteria showed limited mutation detection power and low specificities in Korean FH patients, in whom the best LDL-C threshold for putative mutation was 225 mg/dL. Traditional cardiovascular risk factors were also significantly associated with CAD risk in this population.",
author = "Shin, {Dong Geum} and Han, {Soo Min} and Kim, {Doo Il} and Rhee, {Moo Yong} and Lee, {Byoung Kwon} and Ahn, {Young Keun} and Cho, {Byung Ryul} and Woo, {Jeong Taek} and Hur, {Seung Ho} and Jeong, {Jin Ok} and Yangsoo Jang and Lee, {Ji Hyun} and Lee, {Sang Hak}",
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Clinical features of familial hypercholesterolemia in Korea : Predictors of pathogenic mutations and coronary artery disease - A study supported by the Korean Society of Lipidology and Atherosclerosis. / Shin, Dong Geum; Han, Soo Min; Kim, Doo Il; Rhee, Moo Yong; Lee, Byoung Kwon; Ahn, Young Keun; Cho, Byung Ryul; Woo, Jeong Taek; Hur, Seung Ho; Jeong, Jin Ok; Jang, Yangsoo; Lee, Ji Hyun; Lee, Sang Hak.

In: Atherosclerosis, Vol. 243, No. 1, 01.11.2015, p. 53-58.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical features of familial hypercholesterolemia in Korea

T2 - Predictors of pathogenic mutations and coronary artery disease - A study supported by the Korean Society of Lipidology and Atherosclerosis

AU - Shin, Dong Geum

AU - Han, Soo Min

AU - Kim, Doo Il

AU - Rhee, Moo Yong

AU - Lee, Byoung Kwon

AU - Ahn, Young Keun

AU - Cho, Byung Ryul

AU - Woo, Jeong Taek

AU - Hur, Seung Ho

AU - Jeong, Jin Ok

AU - Jang, Yangsoo

AU - Lee, Ji Hyun

AU - Lee, Sang Hak

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background: Proper screening and diagnosis of familial hypercholesterolemia (FH) is of critical importance for cardiovascular prevention. However, the clinical diagnosis of FH remains difficult partly because its phenotype can vary between different ethnicities. The aim of this study was to determine the clinical features and the best diagnostic approach in Korean FH patients. The predictors of putative pathogenic mutations and coronary artery disease (CAD) were also identified. Methods and Results: Ninety-seven patients with low-density lipoprotein-cholesterol >190 mg/dL and xanthoma or FH-compatible family history were included. Putative pathogenic mutations in LDLR, APOB, or PCSK9 genes were identified in 32% of the enrolled patients. The subjects were classified according to four sets of clinical criteria (Simon Broome, Dutch, MEDPED, Japanese). The mutation rates in definite type FH of Simon Broome or Dutch criteria were 35%-37% and lower in our patients than in those of other countries. The mutation detection rate by MEDPED criteria was 67%-75% and higher than those based on other criteria. The best low-density lipoprotein-cholesterol (LDL-C) threshold for predicting mutations was 225 mg/dL. LDL-C was found to be the only independent predictor of mutation carriers, while hypertension and low high-density lipoprotein-cholesterol were predictive of CAD. Conclusions: The conventional clinical criteria showed limited mutation detection power and low specificities in Korean FH patients, in whom the best LDL-C threshold for putative mutation was 225 mg/dL. Traditional cardiovascular risk factors were also significantly associated with CAD risk in this population.

AB - Background: Proper screening and diagnosis of familial hypercholesterolemia (FH) is of critical importance for cardiovascular prevention. However, the clinical diagnosis of FH remains difficult partly because its phenotype can vary between different ethnicities. The aim of this study was to determine the clinical features and the best diagnostic approach in Korean FH patients. The predictors of putative pathogenic mutations and coronary artery disease (CAD) were also identified. Methods and Results: Ninety-seven patients with low-density lipoprotein-cholesterol >190 mg/dL and xanthoma or FH-compatible family history were included. Putative pathogenic mutations in LDLR, APOB, or PCSK9 genes were identified in 32% of the enrolled patients. The subjects were classified according to four sets of clinical criteria (Simon Broome, Dutch, MEDPED, Japanese). The mutation rates in definite type FH of Simon Broome or Dutch criteria were 35%-37% and lower in our patients than in those of other countries. The mutation detection rate by MEDPED criteria was 67%-75% and higher than those based on other criteria. The best low-density lipoprotein-cholesterol (LDL-C) threshold for predicting mutations was 225 mg/dL. LDL-C was found to be the only independent predictor of mutation carriers, while hypertension and low high-density lipoprotein-cholesterol were predictive of CAD. Conclusions: The conventional clinical criteria showed limited mutation detection power and low specificities in Korean FH patients, in whom the best LDL-C threshold for putative mutation was 225 mg/dL. Traditional cardiovascular risk factors were also significantly associated with CAD risk in this population.

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