Overweight, obesity, and cardiovascular disease in heterozygous familial hypercholesterolaemia: the EAS FH Studies Collaboration registry
Amany ElshorbagyDepartment of Physiology, Faculty of Medicine, University of Alexandria , Mowassat Campus, Alexandria ,Antonio J. Vallejo‐VazCentro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Instituto de Salud Carlos III , Madrid ,Fotios BarkasDepartment of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , White City Campus, 90 Wood Lane, London W12 0BZ ,Alexander R.M. LyonsDepartment of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , White City Campus, 90 Wood Lane, London W12 0BZ ,Christophe StevensDepartment of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , White City Campus, 90 Wood Lane, London W12 0BZ ,Kanika DharmayatDepartment of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , White City Campus, 90 Wood Lane, London W12 0BZ ,Alberico L. CatapanoDepartment of Pharmacological and Biomolecular Sciences, University of Milan , Milan ,Tomáš FreibergerCarDia—National Institute for Metabolic and Cardiovascular Disease Research ,G. Kees HovinghDepartment of Vascular Medicine, Amsterdam UMC, University of Amsterdam , Amsterdam ,Pedro MataFundación Hipercolesterolemia Familiar , Madrid ,Frederick J. RaalCarbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,Raul D. SantosHeart Institute (InCor), University of São Paulo and Hospital Israelita Albert Einstein , São Paulo ,Handrean SoranManchester University NHS Foundation Trust , Manchester ,Gerald F. WattsDepartment of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital , Perth, WA ,Marianne AbifadelFaculty of Pharmacy, Laboratory of Biochemistry and Molecular Therapeutics, Saint Joseph University , Beirut ,Carlos A Aguilar-SalinasTecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Monterrey ,Khalid F. AlHabibDepartment of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University Medical City, King Saud University , Riyadh ,Mutaz Al-KhnifsawiCollege of Medicine, University of Warith Al-Anbiyaa , Karbala ,Wael AlmahmeedCleveland Clinic Abu Dhabi, Heart and Vascular Institute , Abu Dhabi ,Fahad AlnouriCardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre , Riyadh ,Rodrigo AlonsoCentre for Advanced Metabolic Medicine and Nutrition , Santiago ,Khalid Al‐RasadiDepartment of Biochemistry, College of Medicine and Health Science and Medical Research Centre, Sultan Qaboos University , Muscat ,Ahmad Al‐SarrafSabah Al Ahmad Cardiac Centre , Kuwait City ,Marcello ArcaDepartment of Translational and Precision Medicine, Sapienza University of Rome , Rome ,Tester F. AshavaidDepartment of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre Mahim , Mumbai ,Maurizio AvernaDepartment of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo ,Maciej BanachCardiovascular Research Centre, University of Zielona Gora , Zielona Gora ,Marianne BeckerDepartment of Pediatric Endocrinology and Diabetology, Centre hospitalier de Luxembourg , Luxembourg City ,Christoph J. BinderDepartment of Laboratory Medicine, Medical University of Vienna , Vienna ,Mafalda BourbonFaculty of Sciences, Biosystems and Integrative Sciences Institute (BioISI), University of Lisbon , Lisbon ,Liam R. BrunhamDepartments of Medicine and Medical Genetics, Centre for Heart Lung Innovation, The University of British Columbia , Vancouver ,Krzysztof Chlebus1st Department of Cardiology Medical University of Gdańsk, National Centre of Familial Hypercholesterolaemia in Gdańsk , Gdańsk ,Pablo CorralPharmacology Department, FASTA University, School of Medicine , Mar del Plata ,Diogo CruzPortuguese Atherosclerosis Society , Lisbon ,Kairat DavletovResearch Health Institute, Al Farabi Kazakh National University , Almaty ,Olivier DescampsCentres Hospitaliers Universitaires HELORA at La Louvière and University of Mons , Mons ,Bambang DwiputraFaculty of Medicine, Department of Cardiology and Vascular Medicine, Universitas Indonesia—Harapan Kita National Cardiovascular Center , Jakarta ,М. В. ЕжовNational Medical Research Centre of Cardiology of Ministry of Health of the Russian Federation , Moscow ,Urh GrošeljDepartment of Paediatric Endocrinology, Diabetes and Metabolism, University Medical Centre, University Children’s Hospital Ljubljana , Ljubljana ,Mariko Harada‐ShibaOsaka Medical and Pharmaceutical University , Takatsuki ,Kirsten B. HolvenNational Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital , Oslo ,Steve E HumphriesCentre for Cardiovascular Genetics, Institute for Cardiovascular Science, University College London , London ,Meral KayıkçıoğluDepartment of Cardiology, Ege University Medical School , İzmir ,Weerapan KhovidhunkitFaculty of Medicine, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital , Bangkok ,Katarina LalićFaculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade , Belgrade ,Gustavs LatkovskisFaculty of Medicine, Research Institute of Cardiology and Regenerative Medicine, University of Latvia, Pauls Stradins Clinical University Hospital , Riga ,Ulrich LaufsKlinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig , Leipzig ,Evangelos LiberopoulosFirst Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistian University of Athens , Athens ,Marcos M. Lima-MartínezVincent MaherAdvanced Lipid Management and Research Centre (ALMAR), Tallaght University Hospital , Dublin ,A. David MaraisChemical Pathology, University of Cape Town Health Science Faculty , Cape Town ,Winfried MärzDACH Society for the Prevention of Heart and Circulatory Diseases , Hamburg ,Erkin М МirrakhimovCollege of Medicine, Korea University , Seoul ,André R. MiserezDiagene Research Institute and Swiss Society for Familial Forms of Hypercholesterolemia (SSFH) , Reinach ,Olena MitchenkoDepartment of Dyslipidaemia, Institute of Cardiology, National Academy of Medical Sciences , Kiev ,Hapizah NawawiInstitute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA (UiTM) , Sungai Buloh, Selangor ,Børge G. NordestgaardHerlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen , Copenhagen ,Andrie G. PanayiotouDepartment of Rehabilitation Sciences, School of Health Sciences, Cyprus University of Technology , Limassol ,György ParaghFaculty of Medicine, Division of Metabolic Diseases, Department of Internal Medicine, University of Debrecen , Debrecen ,Žaneta PetrulionienėVilnius University Faculty of Medicine and Vilnius University Hospital Santaros Klinikos , Vilnius ,Belma PojskićFaculty of Medicine, Cantonal Hospital Zenica, University of Zenica , Zenica ,Arman PostadzhiyanMedical University of Sofia , Sofia ,Ashraf RedaFaculty of Medicine, Department of Cardiology, Menoufia University , Al Minufiyah ,Željko ReinerDepartment of Internal Medicine, University Hospital Centre Zagreb, and School of Medicine, University of Zagreb , Zagreb ,Ximena ReyesGENYCO Program, Comisión Honoraria para la Salud Cardiovascular , Montevideo ,Fouzia SadiqDirectorate of Research, Shifa Tameer-e-Millat University , Islamabad ,Wilson Ehidiamen SadohDepartment of Child Health, University of Benin Teaching Hospital , Benin City ,Heribert SchunkertClinic for Heart and Circulatory Diseases, German Heart Centre Munich, Technical University Munich , Munich ,Aleksandr B. ShekDepartment of Coronary Heart Disease and Atherosclerosis, Republican Specialized Centre of Cardiology, Ministry of Health of Republic Uzbekistan , Tashkent ,Erik S.G. StroesTa‐Chen SuDepartments of Environmental and Occupational Medicine, and Internal Medicine (Cardiology Division), National Taiwan University Hospital , Taipei ,Tavintharan SubramaniamAdmiralty Medical Centre and Khoo Teck Puat Hospital , Yishun Health ,Andrey V. SusekovFederal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation , Moscow ,Myra TilneyFaculty of Medicine and Surgery, Department of Medicine, University of Malta , Msida ,Brian TomlinsonFaculty of Medicine, Macau University of Science and Technology , Macau ,Thanh Huong TruongFaculty of Medicine, Phenikaa University, Vietnam Atherosclerosis Society , Hanoi ,Alexandros D. TselepisAtherothrombosis Research Centre, University of Ioannina , Ioannina ,Anne Tybjærg-HansenRigshospitalet, Copenhagen University Hospital, University of Copenhagen , Copenhagen ,Alejandra Vázquez-CárdenasDepartamento Académico Ciclo de Vida, Universidad Autónoma de Guadalajara , Av. Patria 1201, Zapopan 45129 ,Margus ViigimaaNorth Estonia Medical Centre, Tallinn University of Technology , Tallinn ,Branislav VohnoutDepartment of Diabetology, LF SZU, Institute of Nutrition, FOaZOS, Coordination Centre for Familial Hyperlipidemias, Slovak Medical University in Bratislava , Bratislava ,Shizuya YamashitaRinku General Medical Centre , Osaka ,Kausik K. RayDepartment of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London , White City Campus, 90 Wood Lane, London W12 0BZ ,
ABI
Abstract
BACKGROUND AND AIMS: Overweight and obesity are modifiable risk factors for atherosclerotic cardiovascular disease (ASCVD) in the general population, but their prevalence in individuals with heterozygous familial hypercholesterolaemia (HeFH) and whether they confer additional risk of ASCVD independent of LDL cholesterol (LDL-C) remains unclear. METHODS: Cross-sectional analysis was conducted in 35 540 patients with HeFH across 50 countries, in the EAS FH Studies Collaboration registry. Prevalence of World Health Organization-defined body mass index categories was investigated in adults (n = 29 265) and children/adolescents (n = 6275); and their association with prevalent ASCVD. RESULTS: Globally, 52% of adults and 27% of children with HeFH were overweight or obese, with the highest prevalence noted in Northern Africa/Western Asia. A higher overweight/obesity prevalence was found in non-high-income vs. high-income countries. Median age at familial hypercholesterolaemia diagnosis in adults with obesity was 9 years older than in normal weight adults. Obesity was associated with a more atherogenic lipid profile independent of lipid-lowering medication. Prevalence of coronary artery disease increased progressively across body mass index categories in both children and adults. Compared with normal weight, obesity was associated with higher odds of coronary artery disease in children (odds ratio 9.28, 95% confidence interval 1.77-48.77, adjusted for age, sex, lipids, and lipid-lowering medication) and coronary artery disease and stroke in adults (odds ratio 2.35, 95% confidence interval 2.10-2.63 and odds ratio 1.65, 95% confidence interval 1.27-2.14, respectively), but less consistently with peripheral artery disease. Adjusting for diabetes, hypertension and smoking modestly attenuated the associations. CONCLUSIONS: Overweight and obesity are common in patients with HeFH and contribute to ASCVD risk from childhood, independent of LDL-C and lipid-lowering medication. Sustained body weight management is needed to reduce the risk of ASCVD in HeFH.
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