Cited by 425Lipoproteins and Cardiovascular HealthGenomics and Rare DiseasesGenetic Associations and Epidemiology

Genetic identification of familial hypercholesterolemia within a single U.S. health care system

Abul-Husn, Noura S., Manickam, Kandamurugu, Jones, Laney K., Wright, Eric A., Hartzel, Dustin N., Gonzaga-Jauregui, Claudia, O’Dushlaine, Colm, Leader, Joseph B. +18 more·2016·Science

Abstract

Unleashing the power of precision medicine: Precision medicine promises the ability to identify risks and treat patients on the basis of pathogenic genetic variation. Two studies combined exome sequencing results for over 50,000 people with their electronic health records. Dewey et al. found that ∼3.5% of individuals in their cohort had clinically actionable genetic variants. Many of these variants affected blood lipid levels that could influence cardiovascular health. Abul-Husn et al. extended these findings to investigate the genetics and treatment of familial hypercholesterolemia, a risk factor for cardiovascular disease, within their patient pool. Genetic screening helped identify at-risk patients who could benefit from increased treatment. Science , this issue p. 10.1126/science.aaf6814 , p. 10.1126/science.aaf7000

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Crossref · 10.1126/science.aaf7000

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53 of 53 references verified0 citation errors · 0 not checkable

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  • The Geisinger validation dataset contains 466 FH cases diagnosed using DLCN criteria, of which 236 were confirmed by genetic testing.

    “The data contain 466 FH cases that have been diagnosed using the DLCN criteria,2 of which 236 FH cases were confirmed by genetic testing.”
  • Untreated lifelong elevation of low-density lipoprotein cholesterol in individuals with familial hypercholesterolemia causes up to a 20-fold excess risk of atherosclerotic cardiovascular disease versus those with normal LDL-C levels.

    “Lifelong elevation of low-density lipoprotein cholesterol (LDL-C) in individuals with FH cause up to a 20-fold excess risk of atherosclerotic cardiovascular disease (ASCVD) versus those with normal LDL-C levels.2,3”
  • Cascade screening of relatives after identifying an individual with familial hypercholesterolemia is highly cost-effective in reducing excess morbidity in family members.

    “In addition, because FH is highly penetrant, once an individual with FH is identified, cascade screening of relatives has been shown to be highly cost-effective in reducing excess morbidity in family members.2,6–8”
  • A familial hypercholesterolemia mutation is present in 0.4% of the population and confers up to 3-fold increased risk for coronary artery disease.

    “An important example is the presence of a familial hypercholesterolemia mutation in 0.4% of the population, which confers an up to 3-fold increased risk for coronary artery disease (CAD).6”
  • For CAD, the prevalence of >3-fold polygenic risk is 20-fold higher than the carrier frequency of rare monogenic mutations conferring comparable risk.

    “Strikingly, the polygenic score identified 20-fold more people than found by familial hypercholesterolemia mutations in previous studies,6,7 at comparable or greater risk.”

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Authors
Abul-Husn, N. S., Manickam, K., Jones, L. K., Wright, E. A., Hartzel, D. N., Gonzaga-Jauregui, C., O’Dushlaine, C., Leader, J. B., Lester Kirchner, H., Lindbuchler, D. M., Barr, M. L., Giovanni, M. A., Ritchie, M. D., Overton, J. D., Reid, J. G., Metpally, R. P. R., Wardeh, A. H., Borecki, I. B., Yancopoulos, G. D., Baras, A., Shuldiner, A. R., Gottesman, O., Ledbetter, D. H., Carey, D. J., Dewey, F. E., & Murray, M. F.
Affiliations
  • Regeneron Genetics Center, Tarrytown, NY 10591, USA.
  • Geisinger Health System (US)
  • Regeneron (United States) (US)
  • Geisinger Health System, Danville, PA 17822, USA.
Corresponding author
Murray, Michael F.
Venue
Science
Published
2016-12-23
Volume
354
Issue
6319
ISSN
  • 0036-8075 (ISSN-L)
  • 1095-9203
OpenAlex
W2567297878
Cited by
425
References
53
Citations by year
2026: 26 · 2025: 25 · 2024: 31 · 2023: 43 · 2022: 46 · 2021: 58 · 2020: 50 · 2019: 50 · 2018: 51 · 2017: 43 · 2016: 2
FWCI
53.87
Type
journal article
Language
en
Open access
closed
Locations
  • Science (publishedVersion)
  • PubMed (publishedVersion)
Funders
Regeneron Pharmaceuticals
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
Keywords
familial hypercholesterolemia, genetic screening, exome sequencing, electronic health records, coronary artery disease risk, statin therapy, LDL cholesterol, underdiagnosis, genetic variants
MeSH terms
Coronary Artery Disease, Delivery of Health Care, Drug Utilization, Coloring Agents, Genetic Testing, Heterozygote, Humans, Hyperlipoproteinemia Type II, Lipoproteins, LDL, United States, Prevalence, Electronic Health Records, Exome

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