Familial Hypercholesterolaemia: An Updated Overall Management

Mohd Kasim, Noor Alicezah and An, Chua Yung and Nawawi, Hapizah (2020) Familial Hypercholesterolaemia: An Updated Overall Management. Journal of Clinical and Heatlh Sciences, 5 (2). pp. 19-38. ISSN 0127-984X


Familial hypercholesterolaemia (FH), the commonest and serious but potentially treatable form of inherited dyslipidaemias, is characterised by severely elevated plasma low-density
lipoprotein-cholesterol (LDL-C) level, which subsequently leads to premature coronary artery disease (pCAD). Effectiveness of FH early detection and treatment is supported by the outcome of several international cohort studies. Optimal FH management relies on prescription of statins either alone or together with other lipid-lowering therapies (LLT). Intensive lifestyle intervention is required in parallel with LLT, which should be commenced at
diagnosis in adults and childhood. Treatment with high intensity statin should be started as soon as possible. Combination with ezetimibe and/or bile acid sequestrants is indicated if target LDL-C is not achieved. For FH patients in the very-high risk category, if their LDL-C targets are not achieved, despite being on maximally tolerated statin dose and ezetimibe, proprotein convertase subtilisin/kexin type1 inhibitor (PCSK9i) is recommended. In statin intolerance, ezetimibe alone, or in combination with PCSK9i may be considered. Clinical evaluation of response to treatment and safety are recommended to be done about 4-6 weeks following initiation of treatment. Homozygous FH (HoFH) patients should be treated with
maximally tolerated intensive LLT and, when available, with lipoprotein apheresis. This review highlights the overall management, and optimal treatment combinations in FH in adults and children, newer LLT including PCSK9i, microsomal transfer protein inhibitor, allele-specific oligonucleotide to ApoB100 and PCSK9 mRNA. Family cascade screening and/or screening
of high-risk individuals, is the most cost-effective way of identifying FH cases and initiating early and adequate LLT.


Item Type: Article
Email / ID Num.
Mohd Kasim, Noor Alicezah
An, Chua Yung
Nawawi, Hapizah
Subjects: R Medicine > RC Internal Medicine
Divisions: Universiti Teknologi MARA, Selangor > Puncak Alam Campus > Faculty of Medicine
Journal or Publication Title: Journal of Clinical and Heatlh Sciences
UiTM Journal Collections: UiTM Journal > Journal of Clinical and Health Sciences (JCHS)
ISSN: 0127-984X
Volume: 5
Number: 2
Page Range: pp. 19-38
Keywords: familial hypercholesterolaemia ; premature coronary heart disease ; lipidlowering therapies ; statin ; ezetimibe ; PCSK9i ; lipoprotein apheresis ; HoFH ; ApoB100
Date: 1 November 2020
URI: https://ir.uitm.edu.my/id/eprint/11223
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