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HuGENet Review

Genetic Causes of Monogenic Heterozygous Familial hypercholesterolemia: A HuGE Prevalence Review Melissa A. Austin1, Carolyn M. Hutter1, Ron L. Zimmern2 and Steve E. Humphries3

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Web Tables

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TABLE 1: Frequency of low-density lipoprotein receptor (LDLR) mutant alleles among familial
hypercholest-erolemia (FH) subjects from founder populations by geographic location

Country/ Ethnicity Study sample and definition of FH* Mutant alleles detected in sample† Mutation Class ‡ Percent of FH individuals (number) with mutant allele Reference
Africa          
South Africa/ Afrikaners 80 unrelated FH heterozygotes from the Afrikaans-speaking section of the South African population. Clinical definition of FH not specified

D206E (Afrikaner-1)

V408M (Afrikaner-2)

D154N (Afrikaner-3)

2

3/5

2

68.7% (55)

15.0% (12)

10.0% (8)

Kotze et al., 1991 (137)
South Africa/ Ashkenazi Jews 10 individuals from two lipid clinics in Cape Town. FH defined as: LDLC§ > 95% for age and gender; presence of tendon xanthomas; and premature ischemic heart disease (age <60 years) in index case or 1st degree relativ 3-bp (GGT) G197 ∆§ in exon 4 (FH- Lithuania) 2 80.0% (8) Meiner et al., 1991 (138)
Americas          
Canada/ French-Canadian (Montreal) 130 individuals unrelated at 2nd degree level from within 50 miles of Montreal. FH defined as: elevated LDLC; tendon xanthomas; family history of hypercholest-erolemia.

>15-kb ∆ promoter in exon 1 (French Canadian-1) C646Y (French Canadian-2)

E207K (French Canadian-3)

W66G (French Canadian-4)

5- kb ∆ exons 2 and 3 (French Canadian-5)

1

3

2

2

NR

59.2% (77)

5.4% (7)

2.3% (3)

6.9% (9)

3.1% (4)

Leitersdorf et al., 1990 (114)

Canada/ French Canadian (Northeastern Quebec)

343 children ages 2-18 years of French Canadian descent. FH defined as: LDLC > 95th percentile for age and sex and either a) tendon xanthomas in 1st or 2nd deg. relative or b) premature CHD§ (< 60) in 1st or 2nd deg. relative

>15-kb ∆ promoter in exon 1 (French Canadian-1) C646Y (French Canadian-2)

E207K (French Canadian-3)

stop 468 (French Canadian-6)

1

3

2

1

 

56.0% (192)

17.8% (61)

6.4 % (12)

4.1% (8)

Simard et al., 1994 (113)
Europe          
Finland/ Finish (North Karelian) 407 individuals attending the lipid outpatient clinic in North Karelia. FH defined as: total serum cholesterol >8 mmol/l; tendon xanthomas in proband and/or 1st degree relative; hypercholest-erolemia in relative of proband.

7-bp ∆ in exon 6 (North Karelia)

9.5-kb ∆ exons 16, 17, 18 (Helsinki)

1

4

83.5% (340)

4.4% (18)

Vuorio et al., 1997 (19)
Finland/ Finish 213 unrelated FH heterozygotes from 5 regions in Finland. Clinical FH defined as: total serum cholesterol >8 mmol/l; tendon xanthomas in proband and/or 1st degree relative; hypercholest-erolemia in relative of proband.

7-bp ∆ from exon 6 (North Karelia)

9.5-kb ∆ exons 16, 17, 18 (Helsinki)

G823D (Turku)

L380H (Pori)

R574Q (Pogosta)

1

4

N.R.

N.R.

N.R.

1

33.8% (72)

34.3% (73)

6.6% (14)

1.9% (4)

1.9% (4)

Koivisto et al., 1995(139) and Vuorio et al., 2001 (34)
Iceland/ Icelandic Proband from 18 unrelated families presenting at lipid clinic in Reykjavik. FH defined as: total plasma cholesterol > 8.5mmol/l; tendon xanthoma in proband or first degree relative; MI§ <age 55 in proband or first degree relative. T>C at 694+2 (Reykjavik) 1 61.1 (11 out of 18 families) Gudnason et al., 1997(33)

* a semicolon in a list implies “and” unless otherwise specified † only alleles occurring with > 1% frequency reported;
nomenclature in parentheses is trivial/common name ‡ Class 1 = null alleles; Class 2 = disrupted transport of receptor;
Class 3 = disrupted binding of LDL to receptor; Class 4 = bound LDL not internalized; Class 5 = receptor recycling defective;
N.R.= not reported, allele class not stated in literature
§ ∆, deletion; LDLC, low-density lipoprotein cholesterol; CHD, coronary heart disease; MI, myocardial infarction;

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TABLE 2: Characterization of molecularly identified mutations in the low-density lipoprotein receptor gene (LDLR) and apolipoprotein B gene (APOB) among familial hypercholesterolemia (FH) subjects from non-founder populations by geographic location:

Country/ Ethnicity Study Sample† Definition of FH Method of Screening for LDLR Mutations Method of Screening for APOB Mutations Number of Distinct Mutations Iden-tified in LDLR and APOB § Percent of FH Sample Mole-cularly Charact-erized for either LDLR or APOB muta-tions Mutant alleles with >10% Frequency in FH Sample Year (Ref-erence)
Africa                
South Africa/ Blacks 14 black hetero-zygous FH patients (4 males, 10 females; age 26-61 years) from lipid clinics in South Africa. Classical FH (12 probands) defined as pretreat-ment TC* >7mmol/l and either tendon xantho-mata or premature CHD* in proband or 1st deg. relative. Probable FH (4 probands) defined as pretreatment TC>7mmol/l and primary hypercholes-terolaemia or premature CHD in the family. HEX-SSCP* of promoter and coding region HEX-SSCP and DGGE* of APOB 7 in LDLR 0 in APOB 64% (9 of 14 indivi-duals) 6-bp ∆* in exon 2 in LDLR (21.4%) None in APOB Thiart et al., 2000 (100)
South Africa/ Mixed Ancestry 236 unrelated hetero-zygous FH adult patients from lipid clinics in Western Cape Province of South Africa. All patients of mixed ancestry. FH defined according to the Simon Broome Register criteria (13). Screened for seven FH mutations common in South African populations Screened for R3500Q 6 in LDLR 1 in APOB 22% (41 of 186 indivi-duals with “definite” FH and 10 of 50 indivi-duals with “probable” FH) None Loubster et al., 1999 (112)
Americas                
Brazil/ Brazilian (European ancestry) 35 unrelated hetero-zygous FH patients (10 males, 25 females; mean age 50 years) from San Paulo City. All of European ancestry. FH defined according to the Dutch lipid clinic criteria (15). SSCP* of promoter and coding regions DNA analysis of codons 3500 and 3531 15 in LDLR 0 in APOB 63% (22 of 35 indivi-duals) G352D in LDLR (11%) A37OT in LDLR (11%) None in APOB Salazar et al., 2002 (98)
Brazil/ Brazilian (multiethnic population) Hetero-zygous FH patients (age 4- 69 years) from 31 unrelated families of various ethnicities in Brazil. TC and LDLC* > 95% for age and sex; triglycerides < 400mg/dl; autosomal inheritance. Screened for Lebanese C660X mutation and gross abnorm-alities in LDLR Screened for R3500Q 2 in LDLR 0 in APOB 32% (10 of 31 families) C660X in LDLR (29%) Alberto et al., 1999 (140)
Canada/ Canadian 60 unrelated hetero-zygous FH patients recruited from lipid clinic patients in Ontario. None with grandparent with French Canadian Ancestry. LDLC>95% for age and sex and tendon xanthomas. Direct sequencing of promoter and coding region Patients with the R3500Q mutation were excluded 25 in LDLR 57% (34 of 60 individuals) None Wang et al., 2001 (99)
Canada/ Canadian (Vancouver) 234 hetero-zygous FH patients identified at a lipid clinic in Vancouver. At least two of: a) total and LDLC >95% for age and sex, b) family history of hypercholes-terolemia and/or premature athereo-sclerosis in 1st deg. relative ( age <55 years for males, <60 years for female) c) physical signs including arcus cornealis and tendon xanhomas. Southern blot hybrid-ization with LDLR cDNA probes to assess major structural rearrange-ments Not considered 6 in LDLR 2.5% (6 of 234 indivi-duals) None Langlois et al., 1988 (141)
Canada/ Chinese 19 unrelated hetero-zygous FH patients of Cantonese ancestry identified at a lipid clinic in Vancouver. At least two of: a) LDLC >95% for age and sex, b) premature CAD* (age <60 years) in 1st deg. relative 3) tendon xantho-mata in index patient or 1st deg. relative or pediatric relative with LDLC >95%. Screened for four mutations known to occur in the Chinese population Not considered 4 in LDLR 21% (4 of 19 indivi-duals) C163R in LDLR (10.5%) Primstone et al., 1998 (96)
Canada/ Chinese 36 hetero-zygous FH patients of Cantonese ancestry from lipid clinic diagnosed with FH. LDLC >95% and premature CAD (age <60 years) in 1st deg. relative Not considered Screened for R3500Q 1 in APOB 2.7% (1 of 36 indivi-duals) None Abdel Wareth et al., 1997 (142)
Asia                
Hong Kong/ Chinese 30 Chinese hetero-zygous FH patients (17 males, 13 females; age 11-80 years) attending lipid clinic in Hong Kong. FH defined according to the Simon Broome Register criteria (13). SSCP of promoter and coding regions Screened for R3500Q 18 in LDLR 0 in APOB 70% (21 of 30 indivi-duals) None Mak et al., 1998 (101)

India/
Indians

25 hyper-cholest-erolemic patients (mean age 40.76 years), selected from individuals attending regular health check-up programs in Mumbai, India. FH defined according to the Simon Broome Register criteria (13). Screened for 4 mutations reported in Indian immigrants in South Africa, and performed modified hetero-duplex analysis of exons 3, 4, 9 and 14 Not considered 2 in LDLR 8% (2 of 25 indivi-duals) None Ashavaid et al., 2000 (143)
Japan/ Japanese 120 unrelated Japanese patients clinically diagnosed as hetero-zygous FH (48 males, 72 females; mean age 45.3 years). TC >6.7 mmol/l and at least one of: a) tendon xanthomas b) a 1st or 2nd deg. relative with tendon xanthomas c) low LDLreceptor activity in fibroblasts Screened for 5 specific mutations Not considered 5 in LDLR 31.7% (38 of 120 indivi-duals) 1845+2 T->C in LDLR (13.3%) Maruyama et al., 1995 (93)
Japan/ Japanese 385 hetero-zygous FH patients from 350 unrelated families (197 males, 188 females; mean age 45 years). Criteria of clinical FH not stated. Not considered Screened for R3500Q 0 in APOB 0% (0 of 385 indivi-duals) None Nohara et al., 1995 (144)
Japan/ Japanese 200 unrelated Japanese hetero-zygous FH patients attending hospitals in Hokuriku district of Japan. (90 men, 110 women; mean age 45.4 years). At least one of: a)TC > 5.9 mmol/l, and <12.9 mmol/l with tendon xanthomas or b) primary hypercholes-terolemia and 1st deg relative meeting criteria a. PCR-DGGE* of all 18 exons. Mutations confirmed by direct sequencing PCR-DDGE of exon 26 (codons 3448- 3562) 37 in LDLR 0 in APOB 62.5% (125 of 200 indivi-duals) K790X in LDLR (19.5%) None in APOB Yu et al., 2002 (102)
Malaysia/ Asian 86 hetero-zygous FH patients (41 males, 45 females; mean age 54 years) attending lipid clinic in Kuala Lumpur: 72 Chinese, 13 Malay and 1 of Indian origin. TC >7.0 mmol/l, triglyceride < 4.0 mmol/l and documented dominant hypercholes-terolemia in family. PCR-DGGE of all 18 exons. Mutations confirmed by direct sequencing Screened for R3500Q 18 in LDLR 0 in APOB 26% (22 of 86 patients) None Khoo et al., 2000 (90)
Europe                
Austria/ Austrians 950 index patients from 23 subcenters around the country. FH defined according to the Dutch lipid clinic criteria (15). DGGE of promoter and all 18 exons Screened for R3500Q 108 in LDLR 1 in APOB 31% (302 of 950 indivi-duals) None Schmidt and Kostner, 2000 (145)
Belgium/ Belgian 70 hetero-zygous FH patients (age 25-65 years) attending lipid clinic in Southern Belgium. TC >95% for sex and age; triglycerides <250 mg/dl and dominant pattern of inheritance. SSCP and restriction analysis of 5’ half of exon 4 Screened for R3500Q 1 in LDLR 1 in APOB 23% (16 of 70 indivi-duals) C122X in LDLR (15.7%) None in APOB Descamps et al. 1997 (146)
Belgium/ Belgian 100 unrelated Flemish speaking hetero-zygous FH patients from University Hospital of Antwerp. FH defined according to the Simon Broome Register criteria (13). Screened for 6 mutations known to occur in the Netherlands Patients with the R3500Q mutation were excluded 3 in LDLR 4% (4 of 100 indivi-duals) None Peeters et al., 1997 (97)
Czech Republic/ Czech Members of 352 unrelated families (551 subjects total) referred from lipid clinics throughout the Czech Republic. Index patients diagnosed with hetero-zygous FH. TC > 8 mmol/l; LDLC > 5 mmol/l; triglycerides < 3.2 mmol/l; family history of premature CHD HEX- SSCP, DGGE, and DNA sequencing of promoter and coding region Screened for mutations in codon 3500 and 3531 of APOB 30 in LDLR 1 in APOB Study still in progress None in LDLR R3500Q in APOB (15.6%) Kuhrova et al., 2002 (103)
Denmark/ Danish 97 hetero-zygous FH patients (59 men, 38 women; mean age 48.5+ 12.8 years) of Danish descent from two lipid clinics in Denmark. TC >8.0 mmol/l; LDLC >6.0 mmol/l; tendon xanthomata in patient or 1st deg. relative; family history of hypercholes-terolemia. SSCP and DNA sequence analysis of coding region Patients with the R3500Q mutation were excluded. 29 in LDLR 80.4% (78 of 97 indivi-duals) W66G in LDLR (15.5%) W23X in LDLR (12.4%) W556S in LDLR (12.4%) Jensen et al., 1999 (94)
Denmark/ Danish 101 unrelated hetero-zygous FH patients. TC> 8mmol/l; LDLC > 6mmol/l; and tendon xanthoma in patient or 1st deg. relative. Not considered Screened for R3500Q 1 in APOB 1.98% (2 of 101 indivi-duals) None Hansen et al., 1994 (83)
France/
French
94 families comprising of 117 from (78 boys, 39 girls; mean age 5.7 + 3.6 years) from a larger study of hypercholest-erolemic children under 15 at teaching hospitals in France. Plasma LDL or LDLC >95% for French children; TG < 140 mg/dL; no obesity or lipid metabolism disorder; positive family history of autosomal dominant hypercholest-erolemia Not considered Screened for R3500Q 1 in APOB 3.2% (3 of 94 families) None Viola et al., 2001 (147)
Germany/ Germans 100 unrelated hetero-zygous FH patients (57 males, 43 females; age 7-68 years) referred from lipid outpatient clinics. TC and LDLC >95%; positive family history of hypercholest-erolemia. PCR- DGGE and direct sequencing of promoter and coding region Screened for R3500Q 37 in LDLR 1 in APOB 56% (56 of 100 indivi-duals) None Nauck et al., 2001 (104)
Greece/
Greek
150 unrelated hetero-zygous FH children (age 2 months-16 years) from all regions of the country. FH defined according to the Dutch lipid clinic criteria (15). Screened for 6 specific mutations Screened for R3500Q 6 in LDLR 0 in APOB 60% (90 of 150 indivi-duals) S265R in LDLR (11.3%) V408M in LDLR (14.7%) D528G in LDLR (22.7%) None in APOB Traeger- Synodinos et al., 1998 (148)
Greece/
Greek (North-western Greek)
73 unrelated hetero-zygous FH patients (34 males, 43 females; age 8-70 years) referred to lipid clinic in North-western Greece. Note: 5 were found to be homo-zygous for FH based on molecular character-ization. FH defined according to the Dutch lipid clinic criteria (15). Restriction digest screening for previously identified LDLR mutations followed by direct sequencing of promoter and coding region Patients with the R3500Q mutation were excluded. 7 in LDLR 100% (73 of 73 indivi-duals) G571E in LDLR (23.5%) D528G in LDLR (25%) S265R in LDLR (16.2%) V408M in LDLR (16.2%) Miltiadous et al., 2001 (89)
Hungary/ Hungarians 73 probands with hetero-zygous FH. 39 identified from family doctor registries, 34 from lipid clinic registries. FH defined according to the Dutch lipid clinic criteria (15). Not considered Screened for R3500Q 1 in APOB 5.4% (4 of 73 indivi-duals) none Kalina et al., 2001 (26)
Italy/
Italians (Southern Italy)
Represent-atives of 51 unrelated families from southern Italy. Index patients diagnosed with hetero-zygous FH. Elevated levels of total plasma cholesterol and LDLC in at least two members of the family and a family history of coronary disease RT-PCR* and complete cDNA sequencing of coding region Not consid-ered 17 in LDLR 72.5% (37 of 51 families) IVS15-3C>A in LDLR (19.6%) Liguori et al., 2001 (105)
The Netherlands and Canada/ Dutch 840 hetero-zygous FH patients referred to a lipid clinic in Amsterdam and 130 hetero-zygous FH patients of Dutch descent referred to lipid clinic in Vancouver, BC. LDLC>95% for age and sex; tendon xanthomas in patient or 1st deg. relative; family history of premature athero-sclerosis and hypercholes-terolemia. Not considered Screened for R3500Q 1 in APOB 1.9% (18 of 970 indivi-duals) None Defesche et al., 1993(149)
The Netherlands/ Dutch Hetero-zygous FH patients from 64 lipid clinics around the country. Number of study subjects not reported, but estimated at approxi-mately 2000 (based on 1641 index cases reported to be about 80% of FH patients studied). FH defined according to the Dutch lipid clinic criteria (15). DGGE and DNA sequencing analysis of promoter and coding region Screened for R3500Q 159 in LDLR 1 in APOB ~80% N543H/2393 ∆ 9 bp in LDLR (~15%) 1359-1 (G->A) in LDLR (~10%) None in APOB Fouchier et al., 2001 (109)
Norway/ Norwegian 476 unrelated patients with “definite” FH primarily (88%) referred from a lipid clinic in Oslo. 266 additional patients with “probable” FH Definite FH defined as: TC >7.8mmol/L; xanthomatas and/or evidence for autosomal dominant inheritance of FH. Definition of probable FH: hypercholes-terolemia (>6.5 mmol/L) SSCP of promoter and coding region Screened for R3500Q 23 in LDLR 1 in APOB 62% (295 of 476 “definite” FH indivi-duals) G>A 331+1 in LDLR (28% of “definite” FH) None in APOB Leren et al., 1997 (106)
Poland/
Polish
30 Polish families with clinical signs of FH. Index cases diagnosed by plasma LDLC > 260 mg/l; normal triglyceride level; tendon xanthomas, and at least one 1st deg. relative with premature (age <60 years) IHD* SSCP of coding region Screened for R3500Q 12 in LDLR 1 in APOB 57% (17 of 30 families) None in LDLR R3500Q in APOB (16.7%) Gorski et al., 1998 (150)
Poland/
Polish
65 patients (42 male, 23 female) with hetero-zygous FH identified in a larger screen of 525 unrelated patients (age 20-82 years) from outpatient lipid clinic in Warsaw. LDLC >190 mg/l, and tendon xanthomas in patient or 1st deg. relative Not considered SSCP screening for R3500Q confirmed by mismatch PCR. 2 in APOB 10.8% (7 of 65 indivi-duals) None in LDLR R3500Q in APOB (9.2%) Bednarska- Makaruk et al., 2001 (74)
Spain/
Spanish
913 hetero-zygous FH patients referred from lipid clinics distributed across Spain. FH defined according to the Dutch lipid clinic criteria (15). None Screened for R3500Q 1 in APOB 1.4% (13 of 913 indivi-duals) None Castillo et al., 2002 (151)
Spain/ Spanish 819 index cases (370 males, 449 females; mean age 47.0) from 68 centers of National Lipid Clinical Network. 350 analyzed for LDLR mutations, 819 for APOB FH defined according to the Dutch lipid clinic criteria (15). Southern blot analysis, SSCP and restriction digest analysis of all 18 exons Screened for R3500Q 86 in LDLR 1 in APOB Total number of patients with mutations not specified None Mata et al., 2002(152)
Spain/ Spanish (Eastern Spain) 113 unrelated hetero-zygous FH patients referred from lipid clinic in eastern area of Spain. TC and LDLC >90%, triglycerides < 75% and at least two of: a) tendon xanthomas, b) hypercholes-terolemic children in family, c) total cholesterol levels >90%, in at least two family members, d) family history of premature heart disease. Southern blot and PCR-SSCP analysis of promoter and coding region SSCP analysis of APOB 47 in LDLR 1 in APOB 69.9% (79 of 113 indivi-duals) None Garcia- Garcia et al., 2001 (107)
Spain/ Spanish (Northeast Spain) 30 unrelated hetero-zygous FH patients referred from lipid clinic in Aragon region. TC and LDLC >90%, triglycerides < 75% and at least two of: a) tendon xanthomas, b) hypercholes-terolemic children in family, c) TC >90% in at least two family members, d) family history of premature heart disease. SSCP analysis of exon 2 and exon 4B Patients with the R3500Q mutation were excluded. 2 in LDLR 33.3% (10 of 30 indivi-duals) E10X in LDLR (20%) 518delG in LDLR (13.3%) Cenarro et al., 1996 (153)
Sweden/ Swedish 150 hetero-zygous FH patients referred to hospitals in Stockholm and Göteborg. TC >90% and either a) tendon xanthomas or b) at least one relative with hypercholes-terolemia or tendon xanthomas SSCP analysis of promoter and coding region Screened for R3500Q 31 in LDLR 1 in APOB 37% (55 of 150 indivi-duals) None Lind et al., 2002 (108) Lind et al., 1998 (154)
Sweden/ Swedish 127 hetero-zygous FH patients (63 males and 64 females) recruited from lipid clinics in Sockholm and Göteborg. LDLC>95% for age and sex; tendon xanthomas in patient or 1st deg. relative; family history of premature athero-sclerosis and hypercholes-terolemia. Not considered Screened for R3500Q 1 in APOB 1.6% (2 of 127 indivi-duals) None Eggertsen et al., 1994 (155)
United Kingdom/ British 227 hetero-zygous FH patients referred from adult or pediatric lipid clinics or from general practitioners. FH defined according to the Simon Broome Register criteria (13). SSCP screening of coding region Screened for R3500Q 47 in LDLR 2 in APOB 28% of adults (32% of definite, 14% of probable) and 53% of children None Heath et al., 2001 (156)
United Kingdom/ British 173 men and women diagnosed as FH hetero-zygotes. FH defined according to the Simon Broome Register criteria (13). Not considered Screened for R3500Q mutation 1 in APOB 3.5% (6 of 173 indivi-duals) None Tybaerg- Hansen et al., 1990 (157)
United Kingdom and United States/ British and American 791 hetero-zygous FH patients (~30% with possible FH). 550 referred from lipid clinics in London, 150 from South-hampton, 60 from Utah. With 20 exceptions, thought to be unrelated. FH defined according to the Simon Broome Register criteria (13). SSCP screening Not consid-ered 51 in LDLR 16.9% (134 of 791 indivi-duals) None Day et al., 1997 (64)
United Kingdom/ British (Southam-pton and south west Hampshire) 78 probands diagnosed as hetero-zygous FH from Southampton and south west Hampshire Elevated LDLC; tendon xanthomas. SSCP of exon 7 Not consid-ered 1 in LDLR 11.5% (9 of 78 indivi-duals) R329X in LDLR (11.5%) Day et al., 1997 (110)
United Kingdom/ British 562 patients with FH (Subset of Whittall et al. 1995 (reference 158) FH defined according to the Simon Broome Register criteria (13). Not considered Screened for R3500Q R3500W and R3531C 1 in APOB 3.0% (17 of 562) None Talmud et al., (159)
United Kingdom/
Irish (Northern Ireland)
93 patients attending lipid clinic at in Belfast. 54 (22 male, 32 female age 17-66 years) with “definite” FH. 39 (11 male, 28 female age 20-66 years) with “probable” FH. FH defined according to the Simon Broome Register criteria (13). Not considered Screened for R3500Q 1 in APOB 5.3% (2 of 54 with “definite” FH, 3 of 39 with “probable” FH) None McClean et al., 1999 (160)
United Kingdom / Scottish (Scotland) 80 apparently unrelated hetero-zygous FH patients from lipid clinics in the west of Scotland with At least one of: a) TC >9 mmol/l and LDLC> 7 mmol/l b) one of: family history of CHD; tendon xanthoma or xanthelasma; personal history of CHD. SSCP analysis and sequencing of exon 4 Patients with the R3500Q mutation were excluded. 7 in LDLR 18.8% (15 of 80 indivi-duals) None Lee et al., 1998 (161)
Middle East                
Israel 193 hetero-zygous FH patients from MED-PED program in Israel, representing multiple ethnic/ national groups. Hypercholes-terolemia w/ LDLC >95% for age and sex; tendon xanthomas; premature IHD in patient or 1st deg. relative PCR, SSCP, DGGE of promoter and coding region for 95 index cases; screening of 98 cases for identified mutations Screened for R3500Q 15 in LDLR 0 in APOB 41.5% (80 of 193 indivi-duals) C660X in LDLR (18.1%) ∆197 in LDLR (11.4%) None in APOB Reshef et al., 1996 (91)
Oceania                
New Zealand/ British 14 apparently unrelated hyperchole-sterolaemic subjects (9 males, 5 females) attending a lipid clinic in New Zealand. Tendon xantho-mata and a positive family history of hypercholes-terolaemia consistant with autosomal dominant inheritance. Screened for mutations in exon 4 Not consid-ered 2 in LDLR 14.2% (2 of 14 individuals) None Theart et al., 1995 (162)

* ∆, deletion; CAD, coronary artery disease; CHD, coronary heart disease; DGGE, denaturing gradient gel electrophoresis; HEX, heteroduplex; IHD, ischemic heart disease; LDLC, low-density lipoprotein cholesterol; PCR, polymerase chain reaction; RT-PCR, reverse transcript polymerase chain reaction; SSCP, single strand conformational polymorphism; TC: total cholesterol, WHO, World Health Organization, † Demographic information on gender and age included if reported in paper ‡ PCR, Polymerase Chain Reaction, SSCP, Single Strand Conformational Polymorphism, DGGE, Denaturing Gradient Gel Electrophoresis, HEX, Heteroduplex § LDLR and APOB are only listed if that gene was screened

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APPENDIX: Web Table References for “Genetic Causes of Monogenic Heterozygous Familial Hypercholesterolemia: A HuGE Prevalence Review”

137. Kotze MJ, Langenhoven E, Warnich L, et al. The molecular basis and diagnosis of familial hypercholesterolaemia in South African Afrikaners. Ann Hum Genet 1991;55:115–21.

138. Meiner V, Landsberger D, Berkman N, et al. A common Lithuanian mutation causing familial hypercholesterolemia in Ashkenazi Jews. Am J Hum Genet 1991;49:443–9.

139. Koivisto UM, Viikari JS, Kontula K. Molecular characterization of minor gene rearrangements in Finnish patients with heterozygous familial hypercholesterolemia: identification of two common missense mutations ( Gly823–>Asp and Leu380–>His ) and eight rare mutations of the LDL receptor gene. Am J Hum Genet 1995;57:789–97.

140. Alberto FL, Figueiredo MS, Zago MA, et al. The Lebanese mutation as an important cause of familial hypercholesterolemia in Brazil . Braz J Med Biol Res 1999;32:739–45.

141. Langlois S, Kastelein JJ, Hayden MR. Characterization of six partial deletions in the low-density-lipoprotein (LDL) receptor gene causing familial hypercholesterolemia (FH). Am J Hum Genet 1988;43:60–8.

142. Abdel-Wareth LO, Pimstone SN, Lagarde JP, et al. Familial defective apolipoprotein B-100 in hypercholesterolemic Chinese Canadians: identification of a unique haplotype of the apolipoprotein B-100 allele. Atherosclerosis 1997;135:181–5.

143. Ashavaid TF, Kondkar AA, Nair KG. Identification of two LDL receptor mutations causing familial hypercholesterolemia in Indian subjects. J Clin Lab Anal 2000;14:293–8.

144. Nohara A, Yagi K, Inazu A, et al. Absence of familial defective apolipoprotein B-100 in Japanese patients with familial hypercholesterolaemia. (Letter). Lancet 1995;345:1438.

145. Schmidt H, Kostner GM. Familial hypercholesterolemia in Austria reflects the multi-ethnic origin of our country. Atherosclerosis 2000;148:431–2.

146. Descamps O, Hondekijn JC, Van Acker P, et al. High prevalence of a novel mutation in the exon 4 of the low-density lipoprotein receptor gene causing familial hypercholesterolemia in Belgium . Clin Genet 1997;51:303–8.

147. Viola S, Benlian P, Morali A, et al. Apolipoprotein B Arg3500Gln mutation prevalence in children with hypercholesterolemia: a French multicenter study. J Pediatr Gastroenterol Nutr 2001;33:122–6.

148. Traeger-Synodinos J, Mavroidis N, Kanavakis E, et al. Analysis of low density lipoprotein receptor gene mutations and microsatellite haplotypes in Greek FH heterozygous children: six independent ancestors account for 60% of probands. Hum Genet 1998;102:343–7.

149. Defesche JC, Pricker KL, Hayden MR, et al. Familial defective apolipoprotein B-100 is clinically indistinguishable from familial hypercholesterolemia. Arch Intern Med 1993;153:2349–56.

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Page last reviewed: April 26, 2004 (archived document)
Page last updated: November 2, 2007
Content Source: CDC's Office of Public Health Genomics