Reducing Premature Coronary Artery Disease in Malaysia by early identification of Familial Hypercholesterolaemia Coronary artery disease (CAD) is the leading cause of illness and death in most countries, including Malaysia, with up to 15% of young Malaysians affected. Identifying the causes for and reducing the incidence of premature CAD is a key national priority in Malaysia.   Familial Hypercholesterolemia (FH) has been identified as an important cause of premature CAD. This is one of the most common inherited conditions and has a high chance of being passed from one generation to another. Individuals with FH have high levels of Low Density Lipoprotein Cholesterol (LDL-C) from birth, known as "bad cholesterol". Left untreated, they are 22 times more likely to have premature CAD than individuals without FH. Early detection and treatment of FH through "statin" cholesterol-lowering drugs can effectively prevent heart attacks. Globally, between 1 in 200 and 1 in 500 people have the more common form of FH (heterozygous FH). Recent reports state as many as 1 in 100 Malaysians maybe affected. However, most of these individuals remain undiagnosed, resulting in lost opportunities to prevent premature CAD.   Improving identification of FH, particularly in primary care, enables early treatment of these individuals. As a result of reducing the risk of premature CAD, this will save lives, improve life expectancy and reduce long-term health expenditure. International guidelines recommend FH case finding using established diagnostic criteria developed from specialist care, specifically Simon-Broome (SB) and Dutch Lipid Clinic Criteria (DLCC). The UK team has demonstrated that using the SB criteria in English primary care setting has a low FH detection (6% of patients fulfilling criteria). To improve FH identification in primary care, the UK team has developed and validated the Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT). On assessment of over 3.7 million British patients with cholesterol measurements in primary care, FAMCAT was between 15 and 20% better at identifying FH than DLCC or SB criteria.  To evaluate how this will perform in Malaysian primary care, we have developed a web-based tool to collect key information to identify individuals with suspected FH using FAMCAT, DLCC or SB criteria. To compare these criteria, when patients attend clinic, they will be invited to provide this information. Using these criteria, patients with suspected FH will be offered genetic testing and examined for features of the condition. Based on the findings of the UK FAMCAT studies, we predict this criteria will perform better by detecting a greater proportion of patients with FH. Having confirmed the best approach to identify suspected FH, the web tool will be refined to be used in primary care clinics. To improve the uptake of this new FH case identification tool, doctors and nurses will be interviewed as they use the tool with dummy patient information.  By introducing genetic testing, we will, firstly, be able to show the type of FH causing genetic mutation found in the Malaysian primary care population. Secondly, we can explore the perception, attitude and experience of individuals who are offered genetic testing and seen in specialist care.   Hence, this project will indicate an acceptable and effective approach to identify FH in Malaysian primary care  and a clearer picture of FH-causing genetic mutations that are found in the Malaysian population leading to better tailored genetic tests. Also, through interviews with patients with suspected FH, primary care doctors and nurses will be able to provide advice to the Ministry of Health and policymakers on how to introduce FH identification in primary care and clinical pathway once tested. This includes advising on guidelines, the training need of health professionals and public health campaigns. Further, this will benefit Malaysian society through reduction in premature CAD, especially in those from the low and middle income groups, and globally enhance the profile of Malaysian The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.