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FH – The basics @LWNurses #LearnWithNurses #LWN Michaela Nuttall RGN MSc Founder, Learn With Nurses Director, Smart Health Solutions Associate in Nursing, C3 Collaborating for Health Chair, Health Care Committee HEART UK Member, Nurses Working Party and Guidelines & Information Working Party, British and Irish Hypertension Society Trustee, PoTS UK @thisismichaela Impact of FH https://heartuk.org.uk/files/uploads/09-15_Rolling_Out_Medway_final.pdf Familial hypercholesterolemia Heterozygous Homozygous • Homozygous FH (HoFH) and Compound • Heterozygous FH (HeFH) have inherited just one Heterozygous FH are severe forms of Familial faulty or altered gene, either from their mother or Hypercholesterolemia which result from inheriting their father. a faulty or altered gene from both parents • Over 260,000 people in the UK may be affected • Cholesterol levels that are exceptionally high, usually between 10 and 20 mmol/L and possibly even higher • 240-300 children and adults in the UK Definite familial hypercholesterolemia is defined as: a) Total cholesterol > 6.7 mmol/l or LDL cholesterol above 4.0 mmol/l in a child < 16 years or Total cholesterol >7.5 mmol/l or LDL cholesterol above 4.9 mmol/l in an adult. (Levels either pre-treatment or highest on treatment) PLUS b) Tendon xanthomas in patient, or in 1st degree relative (parent, sibling, child), or in 2nd degree relative (grandparent, uncle, aunt) OR c) DNA-based evidence of an LDL receptor mutation or familial defective apo B- 100 Possible familial hypercholesterolemia is defined as: or Total cholesterol >7.5 mmol/l or LDL cholesterol above 4.9 mmol/l in an adult. (Levels either pre-treatment or highest on treatment) Plus d) Family history of myocardial infarction: below age of 50 in 2nd degree relative or below age 60 in 1st degree relative or e) Family history of raised cholesterols: >7.5 mmol/l in adult 1st or 2nd degree relative or > 6.7 mmol/l in child or sibling under 16 Potential prevalence Population 1/500 1/300 1/250 SW 1.7 million 3,400 5,667 6,800 London SE London 1.3 million 2,600 4,333 5,200 Potentially 6,000-12,000 people with FH FH Treatment • Statin – Regression of carotid IMT at TC < 6mmol/L (ASAP study) • Cholesterol absorption inhibitor – ezetimibe • Resin/bile acid sequestrant – Cholestyramine • LDL Apheresis • PCSK9 Inhibitors FH Treatment • Lifestyle • Lifestyle • Lifestylewww.heartuk.org In summary • Remember your FH radar • Look for FH then look for it some more
