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Aim: Familial hypercholesterolaemia (FH) is the most common autosomal dominant lipid disorder, leading to severe hypercholesterolaemia. Early detection and treatment with lipid-lowering medications may reduce the risk of premature coronary artery disease in FH patients. However, there is scarcity of data on FH prevalence, detection rate, treatment and control with lipid-lowering therapy in the Malaysian community. Methods: Community participants ( n =5130) were recruited from all states in Malaysia. Blood samples were collected for lipid profiles and glucose analyses. Personal and family medical histories were collected by means of assisted questionnaire. Physical examination for tendon xanthomata and premature corneal arcus were conducted on-site. FH were clinically screened using Dutch Lipid Clinic Network Criteria. Results: Out of 5130 recruited community participants, 55 patients were clinically categorised as potential (Definite and Probable) FH, making the prevalence FH among the community as 1:100. Based on current total population of Malaysia (32 million), the estimated number of FH patients in Malaysia is 320,000, while the detection rates are estimated as 0.5%. Lipid-lowering medications were prescribed to 54.5% and 30.5% of potential and possible FH patients, respectively, but none of them achieved the therapeutic LDL-c target. Conclusion: Clinically diagnosed FH prevalence in Malaysian population is much higher than most of the populations in the world. At community level, FH patients are clinically under-detected, with majority of them not achieving target LDL-c level for high-risk patients. Therefore, public health measures are warranted for early detection and treatment, to enhance opportunities for premature CAD prevention.

Performing vigorous physical activity and taking balanced diet are parts of healthy lifestyles of patients with Familial Hypercholesterolaemia (FH). This study aimed to describe the status of engagement with physical activity and a healthy diet, and their contributing factors. FH patients diagnosed using Dutch Lipid Clinic Network criteria were given validated questionnaires to assess sociodemography, illness characteristics, the status of engagement with physical activity and healthy diet, psychological elements, family support and level of barrier. Significant contributing factors were receiving treatment, level of barrier and intention for behavioural change. The findings may inform the strategy for lifestyle modification of patients with FH. Keywords: Familial Hypercholesterolaemia; lifestyle; physical activity; healthy diet. eISSN: 2514-7528 © 2020 The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment- Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/jabs.v5i17.374

Lifestyle modification is a pivotal intervention for Familial Hypercholesterolaemia (FH). This study aims to describe the lifestyles (physical activity and healthy diet) and their associations with sociodemography, illness characteristics, psychological elements, family support and level of barrier. 100 participants were given Pro forma questionnaires to assess sociodemography and illness characteristics. The lifestyles, psychological elements, family support and level of barrier were assessed using the Theory of Planned Behaviour questionnaire. The determinants of healthy lifestyles include the status of receiving treatment, level of barrier and intention for behavioural change. The findings may inform the strategy for lifestyle modification of FH patients.Keywords: Familial Hypercholesterolaemia; lifestyle; physical activity; healthy diet.eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/ebpj.v5i14.2335

Purpose of review With the exception of familial hypercholesterolaemia, the value of genetic testing for managing dyslipidaemias is not established. We review the genetics of major dyslipidaemias in context of clinical practice. Recent findings Genetic testing for familial hypercholesterolaemia is valuable to enhance diagnostic precision, cascade testing, risk prediction and the use of new medications. Hypertriglyceridaemia may be caused by rare recessive monogenic, or by polygenic, gene variants; genetic testing may be useful in the former, for which antisense therapy targeting apoC-III has been approved. Familial high-density lipoprotein deficiency is caused by specific genetic mutations, but there is no effective therapy. Familial combined hyperlipidaemia (FCHL) is caused by polygenic variants for which there is no specific gene testing panel. Familial dysbetalipoproteinaemia is less frequent and commonly caused by APOE e2e2 homozygosity; as with FCHL, it is responsive to lifestyle modifications and statins or/and fibrates. Elevated lipoprotein(a) is a quantitative genetic trait whose value in risk prediction over-rides genetic testing; treatment relies on RNA therapeutics. Summary Genetic testing is not at present commonly available for managing dyslipidaemias. Rapidly advancing technology may presage wider use, but its worth will require demonstration of cost-effectiveness and a healthcare workforce trained in genomic medicine.

A reversed-phase HPLC method to determine total plasma warfarin was developed and validated. Warfarin was extracted from human plasma using a two-step liquid-liquid extraction method. The residue was reconstituted with a phenylbutazone standard solution, which was used as the internal standard. The analytical column was a Purospher STAR RP-18e (4 x 4mm I.D., 5m particle size). The mobile phase consisted of acetonitrile: potassium dihydrogen orthophosphate buffer solution at pH 6.5 [30:70 (v/v)] with a flow rate of 1mL/min. Both warfarin and phenylbutazone were detected using a photodiode array detector. The lower limit of quantification was 100ng/mL, while the limit of detection was 20ng/mL. The linearity of the assay was good (r2=0.992) in the concentration range from 0.1 - 6.0µg/mL. The extraction recovery of warfarin was 93.53 ± 12.40%. Both the intraday and interday quality control assay for warfarin demonstrated good precision and accuracy, with all of the percentage coefficients of variation being less than 15%. Warfarin was stable in human plasma for up to three months of storage. The validated method was successfully applied to four human samples for a pharmacokinetics study.

Background: Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. Early identification of the coronary risk factors (CRF) among youths assists in determining the high-risk group to develop CAD in later life. In view of the modernised lifestyle, both urban and rural residing youths are thought to be equally exposed to various CRF. This study aimed to describe the common CRF including obesity, dyslipidaemia, hypertension, smoking and family history of premature CAD in Malaysian youths residing in urban and rural areas. Methods: We recruited 942 Malaysian subjects aged 15–24 years old [(males=257, and urban=555 vs rural=387, (mean age + SD = 20.5 + 2.1 years)] from the community health screening programmes organised in both rural and urban regions throughout Malaysia. Medical history and standardised anthropometric measurements were recorded. Laboratory investigations were obtained for fasting serum lipid profiles and plasma glucose levels. Results: Youths in the rural were more overweight and obese (49.4% vs 42.7%, p pppConclusion: In conclusion, rural youths have significantly higher BMI with higher family history of hyperlipidaemia compared to urban youths. However, urban youths have higher LDL-c and TC levels. Other coronary risk factors are not significantly different between urban and rural youths. CRF were significantly more prevalent among rural compared to urban youths.

Familial hypercholesterolaemia is the most common and serious form of inherited hyperlipidaemia. It has an autosomal dominant mode of inheritance, and is characterised by severely elevated low-density lipoprotein cholesterol levels. Familial hypercholesterolaemia is an important cause of premature coronary heart disease, but is potentially treatable. However, the majority of familial hypercholesterolaemia individuals are under-diagnosed and under-treated, resulting in lost opportunities for premature coronary heart disease prevention. This study aims to assess performance of machine learning algorithms for enhancing familial hypercholesterolaemia detection within the Malaysian population. We applied three machine learning algorithms (random forest, gradient boosting and decision tree) to classify familial hypercholesterolaemia among Malaysian patients and to identify relevant features from four well-known diagnostic instruments: Simon Broome, Dutch Lipid Clinic Criteria, US Make Early Diagnosis to Prevent Early Deaths and Japanese FH Management Criteria. The performance of these classifiers was compared using various measurements for accuracy, precision, sensitivity and specificity. Our results indicated that the decision tree classifier had the best performance, with an accuracy of 99.72%, followed by the gradient boosting and random forest classifiers, with accuracies of 99.54% and 99.52%, respectively. The three classifiers with Recursive Feature Elimination method selected six common features of familial hypercholesterolaemia diagnostic criteria (family history of coronary heart disease, low-density lipoprotein cholesterol levels, presence of tendon xanthomata and/or corneal arcus, family hypercholesterolaemia, and family history of familial hypercholesterolaemia) that generate the highest accuracy in predicting familial hypercholesterolaemia. We anticipate machine learning algorithms will enhance rapid diagnosis of familial hypercholesterolaemia by providing the tools to develop a virtual screening test for familial hypercholesterolaemia.

Background Familial hypercholesterolaemia (FH) is the most common inherited metabolic disease with an autosomal dominant mode of inheritance. It is characterised by raised serum levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c), leading to premature coronary artery disease. Children with FH are subjected to early and enhanced atherosclerosis, leading to greater risk of coronary events, including premature coronary artery disease. To the best of our knowledge, this is the first report of a pair of monochorionic diamniotic identical twins with a diagnosis of heterozygous FH, resulting from mutations in both LDLR and ABCG8 genes. Case presentation This is a rare case of a pair of 8-year-old monochorionic diamniotic identical twin, who on family cascade screening were diagnosed as definite FH, according to the Dutch Lipid Clinic Criteria (DLCC) with a score of 10. There were no lipid stigmata noted. Baseline lipid profiles revealed severe hypercholesterolaemia, (TC = 10.5 mmol/L, 10.6 mmol/L; LDL-c = 8.8 mmol/L, 8.6 mmol/L respectively). Their father is the index case who initially presented with premature CAD, and subsequently diagnosed as FH. Family cascade screening identified clinical FH in other family members including their paternal grandfather who also had premature CAD, and another elder brother, aged 10 years. Genetic analysis by targeted next-generation sequencing using MiSeq platform (Illumina) was performed to detect mutations in LDLR, APOB100, PCSK9, ABCG5, ABCG8, APOE and LDLRAP1 genes. Results revealed that the twin, their elder brother, father and grandfather are heterozygous for a missense mutation (c.530C > T) in LDLR that was previously reported as a pathogenic mutation. In addition, the twin has heterozygous ABCG8 gene mutation (c.55G > C). Their eldest brother aged 12 years and their mother both had normal lipid profiles with absence of LDLR gene mutation. Conclusion A rare case of Asian monochorionic diamniotic identical twin, with clinically diagnosed and molecularly confirmed heterozygous FH, due to LDLR and ABCG8 gene mutations have been reported. Childhood FH may not present with the classical physical manifestations including the pathognomonic lipid stigmata as in adults. Therefore, childhood FH can be diagnosed early using a combination of clinical criteria and molecular analyses.

Familial hypercholesterolaemia (FH), the commonest and serious but potentially treatable form of inherited dyslipidaemias, is characterised by severely elevated plasma low-density lipoprotein-cholesterol (LDL-C) level, which subsequently leads to premature coronary artery disease (pCAD). Effectiveness of FH early detection and treatment is supported by the outcome of several international cohort studies. Optimal FH management relies on prescription of statins either alone or together with other lipid-lowering therapies (LLT). Intensive lifestyle intervention is required in parallel with LLT, which should be commenced at diagnosis in adults and childhood. Treatment with high intensity statin should be started as soon as possible. Combination with ezetimibe and/or bile acid sequestrants is indicated if target LDL-C is not achieved. For FH patients in the very-high risk category, if their LDL-C targets are not achieved, despite being on maximally tolerated statin dose and ezetimibe, proprotein convertase subtilisin/kexin type1 inhibitor (PCSK9i) is recommended. In statin intolerance, ezetimibe alone, or in combination with PCSK9i may be considered. Clinical evaluation of response to treatment and safety are recommended to be done about 4-6 weeks following initiation of treatment. Homozygous FH (HoFH) patients should be treated with maximally tolerated intensive LLT and, when available, with lipoprotein apheresis. This review highlights the overall management, and optimal treatment combinations in FH in adults and children, newer LLT including PCSK9i, microsomal transfer protein inhibitor, allele-specific oligonucleotide to ApoB100 and PCSK9 mRNA. Family cascade screening and/or screening of high-risk individuals, is the most cost-effective way of identifying FH cases and initiating early and adequate LLT.

Familial hypercholesterolaemia (FH) causes severe complications including cardiovascular diseases (CVDs) and stroke, leading to poor quality of life (QoL). Despite the availability of advanced treatment, data on QoL and its contributing factors is sparse. Hence, this study aimed to describe the pattern of QoL among FH patients and investigate its association with sociodemographic factors and illness characteristics. Hundred FH patients were assessed using Pro forma questionnaires and World Health Organization QoL questionnaire (WHOQOL-BREF). Significant contributing factors including level of education, income, and the presence and type of CVDs. These findings may help to inform more effective interventions for FH patients. Keywords: Familial hypercholesterolaemia; quality of life; sociodemography; cardiovascular diseaseeISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v4i10.1621

Background/aim: VKORC1 and CYP2C9 genetic polymorphisms may not accurately predict warfarin dose requirements. We evaluated an existing warfarin dosing algorithm developed for Malaysian patients that was based only on VKORC1 and CYP2C9 genes. Materials and methods: Five Malay patients receiving warfarin maintenance therapy were investigated for their CYP2C9*2, CYP2C9*3, and VKORC1-1639G>A genotypes and their vitamin K-dependent (VKD) clotting factor activities. The records of their daily warfarin doses and international normalized ratio (INR) 2 years prior to and after the measurement of VKD clotting factors activities were acquired. The mean warfarin doses were compared with predicted warfarin doses calculated from a genotypic-based dosing model developed for Asians. Results: A patient with the VKORC1-1639 GA genotype, who was supposed to have higher dose requirements, had a lower mean warfarin dose similar to those having the VKORC1-1639 AA genotype. This discrepancy may be due to the coadministration of celecoxib, which has the potential to decrease warfarin's metabolism. Not all patients' predicted mean warfarin doses based on a previously developed dosing algorithm for Asians were similar to the actual mean warfarin dose, with the worst predicted dose being 54.34% higher than the required warfarin dose. Conclusion: Multiple clinical factors can significantly change the actual required dose from the predicted dose from time to time. The additions of other dynamic variables, especially INR, VKD clotting factors, and concomitant drug use, into the dosing model are important in order to improve its accuracy.

This study was conducted to investigate the effects of high-density lipoprotein (HDL) onsecretion and gene expression of intercellular adhesion molecules-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), endothelial-leukocyte adhesion molecule-1 (E-selectin), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) by human vascular endothelial cells (HUVEC). Lipoploysacharides-stimulated HUVEC was incubated with different concentrations of HDL (20-120 mg/dL) for 16 hours. The levels of all biomarkers were measured by ELISA. Total RNA was extracted and all bioamarkers’ mRNA levels were measured by Taqman real-time polymerase chain reaction assay. Different HDL concentrations reduced the secretion and expressonof all biomarkers except VCAM-1, which may contribute to the prevention and regression of atherosclerosis.Keywords: HDL; adhesion molecules; cytokines; endothelial cells; lipopolysaccharides.

The vitamin K epoxide reductase complex 1 gene (VKORC1) is commonly assessed to predict warfarin sensitivity. In this study, a new nested allele-specific multiplex polymerase chain reaction (PCR) method that can simultaneously identify single nucleotide polymorphisms (SNPs) atVKORC1381, 861, 5808, and 9041 for haplotype analysis was developed and validated. Extracted DNA was amplified in the first PCR DNA, which was optimized by investigating the effects of varying the primer concentrations, annealing temperature, magnesium chloride concentration, enzyme concentration, and the amount of DNA template. The amplification products produced from the first round of PCR were used as templates for a second PCR amplification in which both mutant and wild-type primers were added in separate PCR tubes, followed by optimization in a similar manner. The final PCR products were resolved by agarose gel electrophoresis and further analysed by using aVKORC1genealogic tree to infer patient haplotypes. Fifty patients were identified to have H1H1, one had H1H2, one had H1H7, 31 had either H1H7 or H1H9, one had H1H9, eight had H7H7, and one had H8H9 haplotypes. This is the first method that is able to inferVKORC1haplotypes using only conventional PCR methods.

Because durian (Durio zibethinus), which is known in Southeast Asia as "the king of fruits", is thought to have special body-warming properties, it should not be consumed with paracetamol due to a risk of toxic effects. The claim of warming properties, however, has not been scientifically proven. This study was conducted to investigate durian's hyperthermic effect and its toxicity when consumed together with paracetamol in rats. Five groups of rats (n=6) were fed with: 1) distilled water (4 ml/250 g), 2) homogenized durian (4 g/250 g), 3) paracetamol solution (2400 mg/kg), 4) durian (4 g/250 g) followed by paracetamol solution (2400 mg/kg), or 5) prazosin solution (15 mg/kg, pregavaged) followed 1 h later by durian (4 g/250 g) and paracetamol solution (2400 mg/kg). Rectal temperature, systolic blood pressure and serum alanine aminotransferase (ALT) levels were taken from each rat at baseline and after the various administrations at 1, 2 and 5 h. Our results showed that the body temperature of rats in the durian-treated group was not significantly elevated when compared to the control. However, there was a significant decrease in body temperature over time in animals from groups 4 and 5. We did not, however, observe a consistent pattern of blood pressure change. Serum chemical analysis for ALT also did not show any significant change in any of the groups. In conclusion, contrary to what some believe, even though durian was found to increase body temperature in some rats, this increment was not significant. Rats receiving the durian-paracetamol combination showed a significant drop in body temperature, which may explain the belief that the two mixtures are toxic. However, the exact mechanism of toxicity is still unknown.