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Atherosclerosis. 2018 Oct;277:369-376. doi: 10.1016/j.atherosclerosis.2018.05.037.

A Belgian consensus strategy to identify familial hypercholesterolaemia in the coronary care unit and its subsequent cascade screening and treatment: BEL-FaHST (The BELgium Familial Hypercholesterolaemia STrategy).

Author information

1
Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul and Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Bruxelles, Belgium. Electronic address: olivier.descamps@jolimont.be.
2
Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
3
Department of Endocrinology & Nutrition, UCL, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
4
Department of Internal Medecine, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, UCL, Bruxelles, Belgium.
5
Department of Cardiology and Centre for Human Genetics, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
6
Department of Cardiology, Centre Hospitalier Universitaire, Ambroise Paré and Mons University (UMONS), Mons, Belgium.
7
Department of Human Genetics, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
8
Department of Cardiology, Grand Hôpital de Charleroi, Belgium.
9
Department of Cardiology, University Hospital Antwerp, President of the Belgian Society of Cardiology, Belgium.
10
Department of Endocrinology-diabetology-metabolism, UA Antwerp University Hospital, UA Universitair Ziekenhuis Antwerpen, Belgium.
11
Centre de Génétique Humaine, UCL Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
12
Department of Cardiology, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium.
13
Department of Cardiology, Cliniques Universitaires de Mont-Godinne, Belgium.
14
Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
15
Department of Cardiovascular Medicine, Universitaire Ziekenhuizen Leuven, University Hospitals Leuven, Belgium.
16
Department of Cardiology, Algemeen Ziekenhuis, Groeninge, Kortrijk, Belgium.
17
Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium.
18
Department of Cardiology, Centre Hospitalier Régional de la Citadelle, Liège, Belgium.
19
Department of Cardiology, CHU Saint-Pierre and President of the Working Group of Cardiovascular Readaptation and Prevention, Belgium.
20
GIGA Cardiovascular Sciences, Department of Cardiology, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
21
Department of laboratory Medicine, Algemeen Ziekenhuis Sint-Jan, Brugge, and National Representative of the Royal Belgian Society of Laboratory Medicine, Belgium.
22
Department of Cardiology, Centre Hospitalier Universitaire de Tivoli La Louvière, Belgium.
23
Department of Endocrinology, University Hospitals Leuven, Belgium.
24
GIGA I3, Department of Diabetes, Nutrition and Metabolic Diseases, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
25
Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
26
Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerpen, Belgium.
27
Department of laboratory Medicine, Senior Clinical Investigator of the Research Foundation-Flanders (FWO), University Hospital Leuven, The Royal Belgian Society of Laboratory Medicine, Belgium.
28
Department of Diabetes, Nutrition and Metabolic Diseases, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium.
29
Department of Cardiology, University Hospital Ghent and Ghent University, Belgium.

Abstract

BACKGROUND AND AIMS:

Familial hypercholesterolaemia (FH) is an autosomal dominant lipoprotein disorder characterized by significant elevation of low-density lipoprotein cholesterol (LDL-C) and markedly increased risk of premature cardiovascular disease (CVD). Because of the very high coronary artery disease risk associated with this condition, the prevalence of FH among patients admitted for CVD outmatches many times the prevalence in the general population. Awareness of this disease is crucial for recognizing FH in the aftermath of a hospitalization of a patient with CVD, and also represents a unique opportunity to identify relatives of the index patient, who are unaware they have FH. This article aims to describe a feasible strategy to facilitate the detection and management of FH among patients hospitalized for CVD.

METHODS:

A multidisciplinary national panel of lipidologists, cardiologists, endocrinologists and cardio-geneticists developed a three-step diagnostic algorithm, each step including three key aspects of diagnosis, treatment and family care.

RESULTS:

A sequence of tasks was generated, starting with the process of suspecting FH amongst affected patients admitted for CVD, treating them to LDL-C target, finally culminating in extensive cascade-screening for FH in their family. Conceptually, the pathway is broken down into 3 phases to provide the treating physicians with a time-efficient chain of priorities.

CONCLUSIONS:

We emphasize the need for optimal collaboration between the various actors, starting with a "vigilant doctor" who actively develops the capability or framework to recognize potential FH patients, continuing with an "FH specialist", and finally involving the patient himself as "FH ambassador" to approach his/her family and facilitate cascade screening and subsequent treatment of relatives.

KEYWORDS:

Autosomal dominant lipoprotein disorder; Cardiovascular disease; Coronary care unit; Familial hypercholesterolaemia; Low-density lipoprotein cholesterol

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