Screening for Familial Hypercholesterolaemia: What is the most effective strategy?  

Oleh:

Daniels, Stephen R.

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 35 no. 09 (Sep. 2008), page 421.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2008.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background: A screening strategy to identify cases of familial hypercholesterolemia(FH) in the population could dramatically reduce morbidity and mortality from coronary heart disease. Objective: The aims of this study were to establish the age range at which screening for FH is most effective and to identify strategies suitable for a population-based screening program. Design: This was a meta-analysis of published studies that reported the mean total cholesterol and LDL cholesterol levels for patients with heterozygous FH and for control individuals. Studies involving individuals with either a genetic or clinical diagnosis of FH were included. A genetic diagnosis were define as the presence of a mutation in the LDL reseptor genes. Result: A total of 13 studies were included in the mata-analysis, giving a sample of 1,907 patients with a genetic or clinical diagnosis of FH (59.5% and 40.5%, resectively), and 16,221 controls. The median concentrations of total cholesterol and LDL cholesterol among cases were highest in those age 1-9 years (1.87 mltiples of the median [MoM] and 2.30 MoM, respectively) and lowest in those aged 60 years and older (1.27 MoM and 1.14 MoM, respectively). For each false-positive rate, the sensitivity of total cholesterol screening for FH was highest among these aged between 1 and 9 years- at false-positive rates of 0.1%, 0.5% and 1.0%, the sensitivities of total cholesterol screening for FH were 88% (95% Cl 84-92%); 94% (95% Cl 91-97%) and 96% (95% Cl 93-98%), respectively. Similary, the sensitivity of LDL cholesterol screening for FH was highest among those aged 1-9 years, with detection rates of 85%(95% Cl 79-89%), 93% (95 Cl 89-96%) and 96% (95% Cl 92-98%) at false-positive rates of 0.1%, 0.5% and 1.0%, respectively. These findings were unaffected by sex, nature of diagnosis, type of screening program, or patient relationship to controls. Conclusion: Idividuals aged 1-9 years are the best targets population for an FH screening program. The author suggest that cholesterol levels could be measured during routine vaccination of children at 15 months.

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