Criteria for Diagnosis of Familial Hypercholesterolemia: A Comprehensive Analysis of the Different Guidelines, Appraising their Suitability in the Omani Arab Population

Abstract

Subjects with Familial hypercholesterolemia are at increased risk for cardiac events such as premature myocardial infarction and early death from coronary heart disease, especially in patients with severe forms of the disease if left unattended. Therefore, there is an ardent need for the early diagnosis followed by aggressive therapeutic intervention and lifestyle modification. Three groups have developed clinical diagnostic tools for Familial hypercholesterolemia: the US MedPed Program, the Simon Broome Register Group in the United Kingdom, and the Dutch Lipid Clinic Network. In this article, the individual criteria are reviewed with particular emphasis on their advantage(s) and disadvantage(s), and in turn assess their suitability in diagnosing Familial hypercholesterolemia in the Omani Arab population. A brief insight into the process of "Cascade Screening" is also provided, this is a procedure that we are in the process of establishing in Oman.

Keywords: Cascade-Screening; Dutch Criteria; Familial hypercholesterolemia; Omani Arab Population; Simon-Broome Criteria; US-Medped Criteria.

Figure 1

Association between cost of sequencing a Megabase of DNA and Technical Advancement over the last Decade. The cost of sequencing a megabase of DNA with the advent of new generation sequencers have fallen over the last decade and has even defied Moore’s law (solid line in the figure, [data represented from 25]).

Figure 2

Comparison of Temperatures between Muscat and Washington DC throughout the year. Muscat (A), experiences predominant summer temperatures compared with Washington DC (B) and therefore in line with the studies by Ockene et al. the population of Muscat will exhibit significantly higher levels of lipids compared to the population in Washington DC, making the use of US MEDPED criteria difficult in Oman.