Familial hypercholesterolemia in Mexico: Initial insights from the national registry
Roopa Mehta, Alexandro J. Martagón, Gabriela Ramírez, Neftalí Eduardo Antonio-Villa, Arsenio Vargas‐Vázquez, Daniel Elías-López, Gustavo Gonzalez-Retana, Bethsabel Rodríguez-Encinas, José Juan Ceballos-Macías, Alejandro Romero-Zazueta, María R. Martínez-Alvarado, Julieta D. Morales-Portano, Humberto Álvarez‐López, Leobardo Sauque‐Reyna, Laura G. Gomez-Herrera, Luis E. Simental‐Mendía, Humberto García‐Aguilar, Elizabeth Ramírez-Cooremans, Berenice Peña-Aparicio, Victoria Mendoza‐Zubieta, Perla A. Carrillo-González, Aldo Ferreira‐Hermosillo, Nacú Caracas-Portilla, Guadalupe Jiménez-Domínguez, Alinna Y. Ruiz-Garcia, Héctor Eliud Arriaga-Cázares, Jesus R. Gonzalez-Gonzalez, Carla V. Mendez-Valencia, Francisco G. Padilla, Ramón Madriz-Prado, Manuel Odin De los Ríos-Ibarra, Alejandra Vázquez-Cárdenas, Ruy David Arjona-Villicaña, Karina J. Acevedo-Rivera, Ricardo Allende-Carrera, José A. Álvarez, Jose C. Amezcua-Martinez, Manuel de los Reyes Barrera-Bustillo, Gonzalo Carazo-Vargas, Roberto Contreras-Chacon, Mario H. Figueroa-Andrade, Ashanty Flores-Ortega, Héctor García-Alcalá, Laura E. Garcia de Leon, Berenice García-Guzmán, José de Jesús Garduño‐García, Juan C. Garnica-Cuéllar, José Roberto Gómez-Cruz, Anell Hernandez-Garcia, Jesus R. Holguin-Almada, Úrsulo Juárez‐Herrera, Fabiola Lugo-Sobrevilla, Eduardo Márquez-Rodríguez, Cristina Martı́nez-Sibaja, Alma B. Medrano-Rodriguez, Jose C. Morales-Oyervides, Daniel I. Perez-Vazquez, Eduardo Reyes-Rodríguez, Ludivina Robles‐Osorio, Juan Rosas-Saucedo, Margarita Torres‐Tamayo, Luis A. Valdez-Talavera, Luis E. Vera-Arroyo, Eloy Alfonso Zepeda-Carrillo, Carlos A. Aguilar‐Salinas
Abstract
BACKGROUND: Familial hypercholesterolemia (FH) remains underdiagnosed and undertreated. OBJECTIVE: Report the results of the first years (2017-2019) of the Mexican FH registry. METHODS: There are 60 investigators, representing 28 federal states, participating in the registry. The variables included are in accordance with the European Atherosclerosis Society (EAS) FH recommendations. RESULTS: To date, 709 patients have been registered, only 336 patients with complete data fields are presented. The mean age is 50 (36-62) years and the average time since diagnosis is 4 (IQR: 2-16) years. Genetic testing is recorded in 26.9%. Tendon xanthomas are present in 43.2%. The prevalence of type 2 diabetes is 11.3% and that of premature CAD is 9.8%. Index cases, male gender, hypertension and smoking were associated with premature CAD. The median lipoprotein (a) level is 30.5 (IQR 10.8-80.7) mg/dl. Statins and co-administration with ezetimibe were recorded in 88.1% and 35.7% respectively. A combined treatment target (50% reduction in LDL-C and an LDL-C <100 mg/dl) was achieved by 13.7%. Associated factors were index case (OR 3.6, 95%CI 1.69-8.73, P = .002), combination therapy (OR 2.4, 95%CI 1.23-4.90, P = .011), type 2 diabetes (OR 2.8, 95%CI 1.03-7.59, P = .036) and age (OR 1.023, 95%CI 1.01-1.05, P = .033). CONCLUSION: The results confirm late diagnosis, a lower than expected prevalence and risk of ASCVD, a higher than expected prevalence of type 2 diabetes and undertreatment, with relatively few patients reaching goals. Recommendations include, the use of combination lipid lowering therapy, control of comorbid conditions and more frequent genetic testing in the future.