We present clinical practice guidelines for the diagnosis and treatment of homozygous familial hypercholesterolaemia
(HoFH) in the Middle East region. While guidelines are broadly applicable in Europe, in the Middle East we
experience a range of confounding factors that complicate disease management to a point whereby the European guidance
cannot be applied without significant modification. Specifically, for disease prevalence, the Middle East region has an established
epidemic of diabetes and metabolic syndrome that can complicate treatment and mask a clinical diagnosis of
HoFH. We have also a high incidence of consanguineous marriages, which increase the risk of transmission of recessive
and homozygous genetic disorders. This risk is further augmented in autosomal dominant disorders such as familial
hypercholesterolaemia (FH), in which a range of defective genes can be transmitted, all of which contribute to the phenotypic
expression of the disease. In terms of treatment, we do not have access to lipoprotein apheresis on the same scale as
in Europe, and there remains a significant reliance on statins, ezetimibe and the older plasma exchange methods. Additionally,
we do not have widespread access to anti-apolipoprotein B therapies and microsomal transfer protein inhibitors.
In order to adapt existing global guidance documents on HoFH to the Middle East region, we convened a panel of experts
from Oman, Saudi Arabia, UAE, Iran and Bahrain to draft a regional guidance document for HoFH. We also included selected
experts from outside the region. This panel statement will form the foundation of a detailed appraisal of the current
FH management in the Middle Eastern population and thereby provide a suitable set of guidelines tailored for the region.