TY - JOUR
T1 - Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia
AU - Watts, Gerald F.
AU - Sullivan, David R.
AU - Hare, David L.
AU - Kostner, Karam M.
AU - Horton, Ari E.
AU - Bell, Damon A.
AU - Brett, Tom
AU - Trent, Ronald J.
AU - Poplawski, Nicola K.
AU - Martin, Andrew C.
AU - Srinivasan, Shubha
AU - Justo, Robert N.
AU - Chow, Clara K.
AU - Pang, Jing
AU - FH Australasia Network Consensus Working Group
A2 - Ademi, Zanfina
A2 - Ardill, Justin J.
A2 - Barnett, Wendy
A2 - Bates, Timothy R.
A2 - Beilin, Lawrence J.
A2 - Bishop, Warrick
A2 - Black, Andrew J.
A2 - Brett, Peter
A2 - Brown, Alex
A2 - Burnett, John R.
A2 - Bursill, Christina A.
A2 - Colley, Alison
A2 - Clifton, Peter M.
A2 - Ekinci, Elif I.
A2 - Elias, Luke
A2 - Figtree, Gemma A.
A2 - Forge, Brett H.
A2 - Garton-Smith, Jacquie
A2 - Graham, Dorothy F.
A2 - Hamilton-Craig, Ian
A2 - Hamilton-Craig, Christian R.
A2 - Heal, Clare
A2 - Hespe, Charlotte M.
A2 - Hooper, Amanda J.
A2 - Howes, Laurence G.
A2 - Ingles, Jodie
A2 - Irwin, John
A2 - Janus, Edward D.
A2 - Kangaharan, Nadarajah
A2 - Keech, Anthony
A2 - Kirke, Andrew B.
A2 - Kritharides, Leonard
A2 - Kyle, Campbell V.
A2 - Lacaze, Paul
A2 - Lambert, Kirsten
A2 - Li, Stephen C.H.
A2 - Malan, Wynand
A2 - Maticevic, Stjepana
A2 - McQuillan, Brendan M.
A2 - Mirzaee, Sam
A2 - Mori, Trevor A.
A2 - Morton, Allison C.
A2 - Colquhoun, David M.
A2 - Moullin, Joanna C.
A2 - Nestel, Paul J.
A2 - Nowak, Kristen J.
A2 - O'Brien, Richard C.
A2 - Pachter, Nicholas
A2 - Page, Michael M.
A2 - Pedrotti, Annette
A2 - Psaltis, Peter J.
A2 - Radford, Jan
A2 - Reid, Nicola J.
A2 - Robertson, Elizabeth N.
A2 - Ryan, Jacqueline D. M.
A2 - Sarkies, Mitchell
PY - 2020/12/9
Y1 - 2020/12/9
N2 - Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all Australian families with or at risk of FH.
AB - Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all Australian families with or at risk of FH.
U2 - 10.1016/j.hlc.2020.09.943
DO - 10.1016/j.hlc.2020.09.943
M3 - Article
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
SN - 1443-9506
ER -