Familial hypercholesterolaemia is underdiagnosed after AMI

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7278.111 (Published 13 January 2001) Cite this as: BMJ 2001;322:111
  1. Micha F Dorsch (medmfd{at}leeds.ac.uk), British Heart Foundation research fellow,
  2. Richard A Lawrance, British Heart Foundation research fellow,
  3. Nigel P Durham, British Heart Foundation research fellow,
  4. Alistair S Hall, professor of clinical cardiology
  1. British Heart Foundation Heart Research Centre, Leeds General Infirmary, Leeds LS2 9JT

    EDITOR—Neil et al report on the underdiagnosis of familial hypercholesterolaemia in routine practice.1 Unfortunately, things are not much better with regard to care after acute myocardial infarction.

    In 1995 we evaluated the care of 2153 consecutive patients admitted over three months with acute myocardial infarction to 20 adjacent hospitals in the former Yorkshire region. Altogether 404 patients were aged under 60 (age range 32-60; median 53.3 years). Only 292 of these patients had their cholesterol measured—that is, there was an investigation shortfall of 28%. Among these 292 cases we identified 36 cases of familial hypercholesterolaemia. Only six of these patients were already known to have hyperlipidaemia.

    Of even more concern was the fact that only three patients were taking a statin at the time of admission to hospital. This increased to 13 patients at discharge, but there was still a therapeutic shortfall of 64%; this was in a subgroup of patients who had already had a premature coronary event.

    The diagnosis and treatment of the relatives of these patients are also likely to be inadequate. We are aware that we are talking about small numbers of patients, and things may have improved over recent years. But the evidence (the Scandinavian simvastatin survival study (4S)2 and the west of Scotland coronary prevention study (WOSCOP)3) was available before and during our study period. We hope that activities like the United Kingdom's national service frameworks for coronary heart disease will contribute to better care for these patients.


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