Comparative aspects of the care of familial hypercholesterolemia in the “Ten Countries Study”

Jing Pang, Dick C. Chan, Miao Hu, Lauretta A. Muir, See Kwok, Min Ji Charng, Christopher M. Florkowski, Peter M. George, Jie Lin, Do Doan Loi, A. David Marais, Hapizah M. Nawawi, Lourdes E. Gonzalez-Santos, Ta Chen Su, Thanh Huong Truong, Raul D. Santos, Handrean Soran, Brian Tomlinson, Shizuya Yamashita, Zanfina AdemiGerald F. Watts

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)


Background: There is a lack of information on the health care of familial hypercholesterolemia (FH). Objective: The objective of this study was to compare the health care of FH in countries of the Asia-Pacific region and Southern Hemisphere. Methods: A series of questionnaires were completed by key opinion leaders from selected specialist centers in 12 countries concerning aspects of the care of FH, including screening, diagnosis, risk assessment, treatment, teaching/training, and research; the United Kingdom (UK) was used as the international benchmark. Results: The estimated percentage of patients diagnosed with the condition was low (overall <3%) in all countries, compared with ∼15% in the UK. Underdetection of FH was associated with government expenditure on health care (ϰ = 0.667, P <.05). Opportunistic and systematic screening methods, and the Dutch Lipid Clinic Network criteria were most commonly used to detect FH; genetic testing was infrequently used. Noninvasive imaging of coronary calcium and/or carotid plaques was underutilized in risk assessment. Patients with FH were generally not adequately treated, with <30% of patients achieving guideline recommended low-density lipoprotein cholesterol targets on conventional therapies. Treatment gaps included suboptimal availability and use of lipoprotein apheresis and proprotein convertase subtilsin-kexin type 9 inhibitors. A deficit of FH registries, training programs, and publications were identified in less economically developed countries. The demonstration of cost-effectiveness for cascade screening, genetic testing, and specialized treatments were significantly associated with the availability of subsidies from the health care system (ϰ = 0.571–0.800, P <.05). Conclusion: We identified important gaps across the continuum of care for FH, particularly in less economically developed countries. Wider implementation of primary and pediatric care, telehealth services, patient support groups, education/training programs, research activities, and health technology assessments are needed to improve the care of patients with FH in these countries.

Original languageEnglish
Pages (from-to)287-300
Number of pages14
JournalJournal of Clinical Lipidology
Issue number2
Early online date25 Jan 2019
Publication statusPublished - 1 Mar 2019


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