H A W Neil, T Hammond, R Huxley, D R Matthews, S E Humphries
Neil H A W, Hammond T, Huxley R, Matthews D R, Humphries S E.
Extent of underdiagnosis of familial hypercholesterolaemia in routine practice: prospective registry study
BMJ 2000; 321 :148
doi:10.1136/bmj.321.7254.148
Extent of underdiagnosis of familial hypercholesterolaemia after myocardial infarction
22 July 2000
Editor in Chief
BMJ Editorial
BMA House
Tavistock Square
London
WC1J 9JR
Sir
RE: Extent of underdiagnosis of familial hypercholesterolaemia in
routine practice: prospective registry study
We read with great interest the paper of Neil et al. on
underdiagnosis of familial hypercholesterolaemia in routine practice.
Unfortunately things are not much better with regards to care following
acute myocardial infarction.
In 1995 we evaluated the care of 2153 consecutive patients admitted
with acute myocardial infarction to 20 adjacent hospitals in the former
Yorkshire region over a three-month period. Of those, 404 patients were
younger than 60 years of age (age range: 32-60 years; median: 53.3years).
Only 292 of these patients had their cholesterol measured, i.e. there was
an investigation shortfall of 28%. Amongst these 292 cases we were able to
identify 36 cases of familial hypercholesterolaemia. Only 6 of these
patients were already known to have hyperlipaedaemia. Of even more concern
was the therapeutic aspect. Only 3 patients were on a statin at the time
of hospital admission. This increased to 13 patients at discharge but
there was still a therapeutic shortfall of 64% and this in a subgroup of
patients that had already had a premature coronary event.
It is a matter for concern that the diagnosis and treatment of the
relatives of these patients is also likely to be inadequate. We are aware
that we are talking about small numbers of patients and it might be that
things have improved over recent years. However, we want to point out that
the evidence (SSSS, WOSCOP) was already available prior to and during our
study period. It is our hope that activities like the United Kingdom`s
National Service Frameworks for Coronary Heart Disease will contribute to
better care for these patients.
Reference:
1. Neil HAW, Hammond T, Huxley R, Matthews DR, Humphries SE: Extent
of underdiagnosis of familial hypercholesterolaemia in routine practice:
prospective registry study. BMJ.2000; 321:148.
2. [No authors listed]. Randomised trial of cholesterol lowering in
4444 patients with coronary heart disease: the Scandinavian Simvastatin
Survival Study (4S). Lancet. 1994; 344(8934): 1383-9.
3. James Shepherd, Stuart M. Cobbe, Ian Ford, Christopher G. Isles,
A. Ross Lorimer, Peter W. Macfarlane, James H. McKillop, Christopher J.
Packard, for the West of Scotland Coronary Prevention Study Group.
Prevention of Coronary Heart Disease with Pravastatin in Men with
Hypercholesterolaemia. NEJM. 1995; 333 (20): 1301-7.
Yours faithfully
Micha F. Dorsch (MRCP MD), British Heart Foundation Research Fellow,
The BHF Heart Research Centre, Jubilee Wing, Leeds General Infirmary,
Leeds, LS2 9JT, UK,
Tel: 0113 2334807 E-mail: medmfd@leeds.ac.uk
Richard A Lawrance (MRCP), British Heart Foundation Research Fellow,
The BHF Heart Research Centre, Jubilee Wing, Leeds General Infirmary,
Leeds, LS2 9JT, UK,
Nigel P Durham (BM BS MRCP), British Heart Foundation Research
Fellow, The BHF Heart Research Centre, Jubilee Wing, Leeds General
Infirmary, Leeds, LS2 9JT, UK,
Alistair S. Hall (MB ChB MRCP PhD), Professor of Clinical Cardiology,
The BHF Heart Research Centre, Jubilee Wing, Leeds General Infirmary,
Leeds, LS2 9JT, UK,
Competing interests: No competing interests