Outcome of case finding among relatives of patients with known heterozygous familial hypercholesterolaemia

Objectives To assess the feasibility of detecting new cases of heterozygous familial hypercholesterolaemia by using a nurse led genetic register. Design Case finding among relatives of patients with familial hypercholeste rolaemia. Setting Two lipid clinics in central and south Manchester. Subjects 259 (137 men and 122 women) probands and 285 first degree relative s. Results Of the 200 first degree relatives tested, 121 (60%) had inherited f amilial hypercholesterolaemia. The newly diagnosed patients were younger th an the probands and were generally detected before they had clinically over t atherosclerosis. Concentrations of serum cholesterol were, respectively, 8.4 (1.7 SD) mmol/l and 8.1 (1.9 SD) mmol/l in affected men and women and 5 .6 (1.0 SD) mmol/l and 5.6 (1.1 SD) mmol/l in unaffected men and women. Scr eening for risk factors as recommended in recent guidelines for coronary he art disease prevention would have failed to identify most of the affected r elatives in whom hypertension, diabetes mellitus, cigarette smoking, and ob esity were uncommon. Conclusions By performing cholesterol tests on 200 relatives, 121 new patie nts with familial hypercholesterolaemia were discovered. Because 1 in 500 p eople in the United Kingdom affected by this condition, to detect a similar number by population screening over 60 000 tests would be required, and on ly a few of` these patients would have been detected had cholesterol testin g been restricted to those with other risk factors for coronary heart disea se. A case exists for organising a genetic register approach, linking lipid clinics nationally.