Limits...
Identification and Treatment of Patients with Homozygous Familial 
 Hypercholesterolaemia: Information and Recommendations from a 
 Middle East Advisory Panel

View Article: PubMed Central - PubMed

ABSTRACT

We present clinical practice guidelines for the diagnosis and treatment of homozygous familial hypercholesterolaemia (HoFH) in the Middle East region. While guidelines are broadly applicable in Europe, in the Middle East we experience a range of confounding factors that complicate disease management to a point whereby the European guidance cannot be applied without significant modification. Specifically, for disease prevalence, the Middle East region has an established epidemic of diabetes and metabolic syndrome that can complicate treatment and mask a clinical diagnosis of HoFH. We have also a high incidence of consanguineous marriages, which increase the risk of transmission of recessive and homozygous genetic disorders. This risk is further augmented in autosomal dominant disorders such as familial 
hypercholesterolaemia (FH), in which a range of defective genes can be transmitted, all of which contribute to the phenotypic expression of the disease. In terms of treatment, we do not have access to lipoprotein apheresis on the same scale as in Europe, and there remains a significant reliance on statins, ezetimibe and the older plasma exchange methods. Additionally, we do not have widespread access to anti-apolipoprotein B therapies and microsomal transfer protein inhibitors. In order to adapt existing global guidance documents on HoFH to the Middle East region, we convened a panel of experts from Oman, Saudi Arabia, UAE, Iran and Bahrain to draft a regional guidance document for HoFH. We also included selected experts from outside the region. This panel statement will form the foundation of a detailed appraisal of the current FH management in the Middle Eastern population and thereby provide a suitable set of guidelines tailored for the region.

No MeSH data available.


Related in: MedlinePlus

Genetic diversity of homozygous familial hypercholesterolaemia (HoFH).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4997916&req=5

Figure 3: Genetic diversity of homozygous familial hypercholesterolaemia (HoFH).

Mentions: HoFH patients may be ‘true homozygotes’, with the same mutation in both alleles of the same gene, or ‘compound heterozygotes’ with different mutations in the two alleles of the same gene. Patients may also carry mutations in two different genes affecting LDL receptor function (Fig. 3). The severity of the mutation is a major factor governing the severity of the phenotype. Patients with mutations resulting in defective LDL-R usually have less elevated LDL-C than patients with mutations resulting in a complete absence of LDL-R activity [8]. Generally, the pattern of mean LDL-C levels by genotype increase as follows: HeFH < double heterozygote (e.g. LDL+PCSK9 gain-of-function or apo B mutation) < homozygous apo B or PCSK9 gain-of-function mutation < homozygous LDLRAP1 or LDLR-defective mutations < compound heterozygote LDLR-defective+LDLR-negative mutations < homozygous LDLR-negative mutations [8].


Identification and Treatment of Patients with Homozygous Familial 
 Hypercholesterolaemia: Information and Recommendations from a 
 Middle East Advisory Panel
Genetic diversity of homozygous familial hypercholesterolaemia (HoFH).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997916&req=5

Figure 3: Genetic diversity of homozygous familial hypercholesterolaemia (HoFH).
Mentions: HoFH patients may be ‘true homozygotes’, with the same mutation in both alleles of the same gene, or ‘compound heterozygotes’ with different mutations in the two alleles of the same gene. Patients may also carry mutations in two different genes affecting LDL receptor function (Fig. 3). The severity of the mutation is a major factor governing the severity of the phenotype. Patients with mutations resulting in defective LDL-R usually have less elevated LDL-C than patients with mutations resulting in a complete absence of LDL-R activity [8]. Generally, the pattern of mean LDL-C levels by genotype increase as follows: HeFH < double heterozygote (e.g. LDL+PCSK9 gain-of-function or apo B mutation) < homozygous apo B or PCSK9 gain-of-function mutation < homozygous LDLRAP1 or LDLR-defective mutations < compound heterozygote LDLR-defective+LDLR-negative mutations < homozygous LDLR-negative mutations [8].

View Article: PubMed Central - PubMed

ABSTRACT

We present clinical practice guidelines for the diagnosis and treatment of homozygous familial hypercholesterolaemia (HoFH) in the Middle East region. While guidelines are broadly applicable in Europe, in the Middle East we experience a range of confounding factors that complicate disease management to a point whereby the European guidance cannot be applied without significant modification. Specifically, for disease prevalence, the Middle East region has an established epidemic of diabetes and metabolic syndrome that can complicate treatment and mask a clinical diagnosis of HoFH. We have also a high incidence of consanguineous marriages, which increase the risk of transmission of recessive and homozygous genetic disorders. This risk is further augmented in autosomal dominant disorders such as familial &#8232;hypercholesterolaemia (FH), in which a range of defective genes can be transmitted, all of which contribute to the phenotypic expression of the disease. In terms of treatment, we do not have access to lipoprotein apheresis on the same scale as in Europe, and there remains a significant reliance on statins, ezetimibe and the older plasma exchange methods. Additionally, we do not have widespread access to anti-apolipoprotein B therapies and microsomal transfer protein inhibitors. In order to adapt existing global guidance documents on HoFH to the Middle East region, we convened a panel of experts from Oman, Saudi Arabia, UAE, Iran and Bahrain to draft a regional guidance document for HoFH. We also included selected experts from outside the region. This panel statement will form the foundation of a detailed appraisal of the current FH management in the Middle Eastern population and thereby provide a suitable set of guidelines tailored for the region.

No MeSH data available.


Related in: MedlinePlus