【論文摘要】ASCVD in Patients with Familial Hypercholesterolemia in Asian Countries

Brian Tomlinson

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 9-9

https://doi.org/10.6907/SCJ.201909/SP_1(2).0009

摘要

Most Asian countries have lower population cholesterol levels than Western countries, although the difference is becoming less. Likewise, LDL cholesterol levels in patients with familial hypercholesterolemia (FH) in Asian countries tend to be lower than in their western counterparts. Consequently, atherosclerotic cardiovascular disease (ASCVD) is probably less prevalent in patients with FH in Asian countries compared with those in Western countries. This pattern is likely to change as cholesterol levels are rising in Asian countries, notably in China. The prevalence of FH in Asian countries is not really known, but from the few studies available, it appears to be similar to that in other countries where there is no founder effect. The pattern of common mutations causing FH is somewhat different in Asian countries compared to the common mutations found elsewhere. As in other countries, the functional variants involve loss-of-function mutations in the LDL receptor gene and the apolipoprotein B gene and gain-of-function mutations in the proprotein convertase subtilisin/kexin 9 (PCSK9) gene. A study that examined the awareness, knowledge, and perception of FH among practitioners in some Asian countries found there were substantial gaps in many areas. Some of the Asian countries have developed country-specific guidelines for FH and many patients have been identified by opportunistic and cascade screening. A high prevalence of clinically diagnosed FH has been identified in patients with coronary artery disease, especially in those with premature disease. Treatment with statins is available in all Asian countries, although in some countries this is not government funded. The PCSK9 inhibitors have been introduced in some Asian countries, but reimbursement is often limited so there is some restriction in their usage. Considering that there is still a general lack of awareness of making the diagnosis of FH and of the need to treat FH patients to a more aggressive goal of LDL cholesterol, because of the increased cardiovascular risk associated with carrying an FH mutation, there is a need for further education of medical professionals and the general population in Asian countries. Patient support groups have not been established in most Asian countries and this represents an area that could be developed.