Familial hypercholesterolemia screening program in Bosnia and Herzegovina and cardiovascular morbidity.

Background And Aims: We aimed to estimate the frequency of cardiovascular diseases in familial hypercholesterolemia (FH) patients in Bosnia and Herzegovina.

Methods: We screened lipid profiles in the hospital system during the period March 2008-November 2016, and included 307 patients with LDL>4.5 mmol/L. FH was diagnosed according to the Dutch Lipid Clinic Network (DLCN) criteria. Followed parameters were: the presence of coronary artery disease (CAD), premature CAD (defined as men<55yrs,women<65yrs), cerebral vascular disease (CVD). Patients were divided into 4 groups according to the DLCN criteria: Group1 - definite FH, Group2 - probable FH, Group 3 - possible FH, Group4 - unlikely FH. Patients with incomplete data and secondary causes of hyperlipidemia were not included. Statistical analysis was done using the SPSS software package Version 19.0.

Results: There were 307 patients. Group1 counted 16 patients; Group2, 56; Group3, 140, and Group4, 95. In Group1, CAD was diagnosed in 7 patients (43.75%); PCAD in 7 (43.75%); CVD in 2 (12.5%). In Group2, CAD was diagnosed in 25 patients (44.6%); PCAD in 23 (41.1%); and CVD in 8 (14.3%). In Group3, CAD was diagnosed in 64 cases (45.7%); PCAD in 29 (20.7%); and CVD in 47 (33.6%). In Group4, CAD was diagnosed in 19 patients (20%); PCAD in 3 (3.2%); and CVD in 73 (76.8%). CAD was significantly more present in Groups 1,2 and 3 compared with Group4. Occurrence of PCAD was statistically significant in patients with definite and probable FH compared with Groups 3 and 4 (p < 0.05). There was a significant difference in the appearance of CVD in Group4 compared with Groups 1,2 and 3.

Conclusions: Definitive and possible FH groups were strongly associated with PCAD and CAD, while CVD was significantly higher in the unlikely FH group. Screening program and worldwide information exchange are essential to spread the knowledge about FH prevalence.