Integrated Guidance for Enhancing the Care of Familial Hypercholesterolaemia in Australia

Gerald F Watts, David R Sullivan, David L Hare, Karam M Kostner, Ari E Horton, Damon A Bell, Tom Brett, Ronald J Trent, Nicola K. Poplawski, Andrew C Martin, Shubha Srinivasan, Robert N. Justo, Clara K. Chow, Jing Pang, on behalf of the FH Australasia Network Consensus Working Group

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Abstract

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 (see figure 1; tables 1 to 9), 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 five 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 (tables 1 to 3, 6 to 8). Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH (tables 4 and 5). 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, PCSK9 inhibitors and lipoprotein apheresis (tables 6 to 8). Broad recommendations are also provided for the organisation and development of healthcare services (table 9). 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 healthcare 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.
Original languageEnglish
Number of pages74
JournalHeart Lung and Circulation
Publication statusAccepted/In press - 25 Sep 2020

Cite this

Watts, G. F., Sullivan, D. R., Hare, D. L., Kostner, K. M., Horton, A. E., Bell, D. A., Brett, T., Trent, R. J., Poplawski, N. K., Martin, A. C., Srinivasan, S., Justo, R. N., Chow, C. K., Pang, J., & on behalf of the FH Australasia Network Consensus Working Group (Accepted/In press). Integrated Guidance for Enhancing the Care of Familial Hypercholesterolaemia in Australia. Heart Lung and Circulation.