VRONI goes North – FH paediatric screening in Germany

FH paediatric screening program gets national visibility and importance as part of cardiovascular heart health agenda in Germany and across Europe.

VRONI is a screening program for Familial Hypercholesterolemia (FH) and was successfully launched in 2021 as part of the DigiMed project in Bavaria, Germany. In the context of any pediatric check-up, children aged 5 to 14 years are invited to participate. The screening follows a two-step approach: Primarily LDL-cholesterol is measured centrally from capillary or venous blood-samples. For individuals above the predefined threshold of 130 mg/dl (i. e. roundabout the 95^th percentile in this age group) a dedicated FH-panel is used for genetic analysis. FH-positive children are registered and treated by specialized paediatricians and paediatric cardiologists. Furthermore, certified training centres offer affected families FH-focused training courses. For first-degree relatives of FH-positive children reverse cascade screening is facilitated to identify affected family members.

Recruitment started in early 2021 and by now more than 480 paediatricians in Bavaria screened over 12.000 children. Approximately 7% of them exceeded the predefined LDL-C threshold of 130 mg/dl (3.34 mmol/l). Over 120 children with pathogenic FH-mutations were identified by VRONI in Bavaria.

The German Cardiac Society (DGK) became aware of the project and offered to expand the activities to other parts of the Country. FH-screening became a flagship project of the German Heart Alliance, which brings together all German academic societies with focus on the heart, the German Heart Foundation (Deutsche Herzstiftung) and the political leadership including the federal Minister for Health, Prof. Karl Lauterbach. The joint plan is to expand the successful VRONI concept from Bavaria to the northern parts of Germany. In close collaboration with the study centre in Hanover led by Thomas Danne and Olga Kordonouri preparations are underway for a timely start of “VRONI im Norden”, offering the same FH screening program to children aged 5 to 14 years at local participating paediatricians in the north of Germany.

Overall VRONI aims to incorporate molecular and clinical diagnostics into a systematic effort to identify individuals with FH early on, followed by a multidisciplinary treatment approach, spanning patient education and counselling as well as regular follow-up assessments. Additionally with reverse cascade screening other affected family members should be diagnosed and treated.

The expansion of VRONI to the northern parts of Germany is intended to lay the foundation for implementing a FH screening in the standard care in Germany. In this context, the VRONI study (in northern Germany and Bavaria) is an important representative of the European-wide initiative, that is being pursued with the “Prague Declaration” (The time is now: Achieving FH paediatric screening across Europe – The Prague Declaration) published by FH Europe international community and launched at the Czech Senate meeting in Prague in 2022, under the auspices of the Czech Presidency of the EU.

Prepared by

Prof. Dr. med. Heribert Schunkert and  Dr. med. Veronika Sanin

Additional resources:

• Population-based screening in children for early diagnosis and treatment of familial hypercholesterolemia: design of the VRONI study – https://pubmed.ncbi.nlm.nih.gov/35165720/
• The Prague Declaration – endorse it here https://fheurope.org/policy/prague-declaration/  
• The time is now: Achieving FH paediatric screening across Europe – The Prague Declaration https://pubmed.ncbi.nlm.nih.gov/36311985/