Today we will highlight the first two sessions from Day 2 of the FH Global Summit in part 2 of our 4-part series. If you missed our previous edition, you can read it here .
FH as a Prototype for Precision Public Health
Dr. Muin Khoury, founding director of the Office of Genomics and Precision Public Health at the Centers for Disease Control and Prevention, kicked off Day 2 by discussing how familial hypercholesterolemia (FH) sets the stage for precision public health for other inherited conditions and the progress we have made identifying and treating individuals with FH. Khoury underscored the importance of data for more precisely developing and delivering public health programs to sub-populations: “Families live across states and healthcare systems. We can’t do this without precision.”

Rear Admiral Betsy Thompson, head of the CDC’s Department of Heart Disease and Stroke prevention, underlined how FH and cholesterol are aligned with the strategic priorities of the CDC. Today, 39.1 million people in the U.S. are not using statins when indicated, according to NHANES data. It may be possible to prevent over 300,000 heart events per year just by increasing cholesterol management to 80% of those who are eligible for statins.

The “challenges and opportunities for integrating FH into state public health programs” were underscored by Deb Lochner Doyle’s talk. Opportunities for improvement currently being evaluated by the state of Washington include:

  • investigating population-based screening

  • adding a state performance measure for lipid screening in 9 to 11-year-olds

  • linking families at-risk to care via the “Cascade Screening Connector”

"Cascade screening is not happening very well in this country. Why not? Because it is very time consuming and no one pays for it. Perhaps this is a role for public health."
– Debra Lochner Doyle, MS, LCGC
Precision Targeting and Screening to FIND FH
Dr. Dan Rader opened the second session by announcing the results of the FIND FH validation study, which were simultaneously published in Lancet Digital Health . The study shows that FIND FH can be applied to both large health claims lab databases and electronic health records—two very different types of data—and perform equally effectively in both. He also noted the scale of the project, stating that the FIND FH model was run on 170 million records and identified 1.3 million individuals with possible FH.

"Finding FH" is also a priority of the Million Veterans Program, which currently includes 800,000 veterans (20% Blacks and 8% Hispanics). Dr. Peter Wilson shared results on statin initiation with individuals who were
previously statin naïve. With intervention, they were able to increase initiation from 20-33% to 62% in this group. “Is that a win? Well, yes, but we can do better,” Dr. Wilson added. The data also showed that while Whites are more likely to start on statins, Blacks are more likely to stay on statins once they start.

Dr. Yan Sun highlighted the distribution and phenotypic effects of individual and collective FH variants within the Million Veterans Program. The FH variants differ between European and African Americans, and some variants are only found within the African American group. There was a 60% increase in coronary heart disease with an FH variant, and researchers are currently analyzing whether having an FH variant can lead to other co-morbidities.