Overweight, obesity, and cardiovascular disease in heterozygous familial hypercholesterolaemia: the EAS FH Studies Collaboration registry

Abstract

Description

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.
Fil: Elshorbagy Amany. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Elshorbagy Amany. Department of Physiology, Faculty of Medicine, University of Alexandria; Egipto
Fil: Vallejo-Vaz Antonio J. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Vallejo-Vaz Antonio J. Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC; España
Fil: Vallejo-Vaz Antonio J. Faculty of Medicine, Department of Medicine, University of Seville; España
Fil: Vallejo-Vaz Antonio J. Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Instituto de Salud Carlos III; España
Fil: Barkas Fotios. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Barkas Fotios. Faculty of Medicine, Department of Internal Medicine, School of Health Sciences, University of Ioannina; Grecia
Fil: Lyons Alexander R.M. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Stevens Christophe A.T. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Dharmayat Kanika I. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido
Fil: Catapano Alberico L. Department of Pharmacological and Biomolecular Sciences, University of Milan; Italia
Fil: Catapano Alberico L. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica; Italia
Fil: Freiberger Tomas. Centre for Cardiovascular Surgery and Transplantation, and Medical Faculty, Masaryk University; República Checa
Fil: Freiberger Tomas. CarDia—National Institute for Metabolic and Cardiovascular Disease Research; República Checa
Fil: Hovingh G. Kees. Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam; Países Bajos
Fil: Hovingh G. Kees. Novo Nordisk; Dinamarca
Fil: Mata Pedro. Fundación Hipercolesterolemia Familiar; España
Fil: Raal Frederick J. Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand; Sudáfrica
Fil: Santos Raul D. Heart Institute (InCor), University of São Paulo and Hospital Israelita Albert Einstein; Brasil
Fil: Soran Handrean. Manchester University NHS Foundation Trust; Reino Unido
Fil: Watts Gerald F. Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia; Australia
Fil: Watts Gerald F. Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital; Australia
Fil: Abifadel Marianne. Faculty of Pharmacy, Laboratory of Biochemistry and Molecular Therapeutics, Saint Joseph University; Líbano
Fil: Aguilar-Salinas Carlos A. Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; México
Fil: Aguilar-Salinas Carlos A. Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud; México
Fil: Alhabib Khalid F. Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University Medical City, King Saud University; Arabia Saudita
Fil: Alkhnifsawi Mutaz. College of Pharmacy, University of Al Qadisiyah; Irak
Fil: Alkhnifsawi Mutaz. College of Medicine, University of Warith Al-Anbiyaa; Irak
Fil: Almahmeed Wael. Cleveland Clinic Abu Dhabi, Heart and Vascular Institute; Emiratos Árabes Unidos
Fil: Alnouri Fahad. Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre; Arabia Saudita
Fil: Alonso Rodrigo. Centre for Advanced Metabolic Medicine and Nutrition; Chile
Fil: Al-Rasadi Khalid. Department of Biochemistry, College of Medicine and Health Science and Medical Research Centre, Sultan Qaboos University; Omán
Fil: Al-Sarraf Ahmad. Sabah Al Ahmad Cardiac Centre; Kuwait
Fil: Arca Marcello. Department of Translational and Precision Medicine, Sapienza University of Rome; Italia
Fil: Ashavaid Tester F. Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre Mahim; India
Fil: Averna Maurizio. Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo; Italia
Fil: Averna Maurizio. Istituto di Biofisica, Consiglio Nazionale delle Ricerche; Italia
Fil: Banach Maciej. Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL); Polonia
Fil: Banach Maciej. Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI); Polonia
Fil: Banach Maciej. Cardiovascular Research Centre, University of Zielona Gora; Polonia
Fil: Becker Marianne. Department of Pediatric Endocrinology and Diabetology, Centre hospitalier de Luxembourg; Luxemburgo
Fil: Binder Christoph J. Department of Laboratory Medicine, Medical University of Vienna; Austria
Fil: Bourbon Mafalda. Unidade de Investigação e Desenvolvimento, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge; Portugal
Fil: Bourbon Mafalda. Faculty of Sciences, Biosystems and Integrative Sciences Institute (BioISI), University of Lisbon; Portugal
Fil: Brunham Liam R. Departments of Medicine and Medical Genetics, Centre for Heart Lung Innovation, The University of British Columbia; Canadá
Fil: Chlebus Krzysztof. 1st Department of Cardiology Medical University of Gdańsk, National Centre of Familial Hypercholesterolaemia in Gdańsk; Polonia
Fil: Corral Pablo. Universidad FASTA. Facultad de Ciencias Médicas; Argentina
Fil: Cruz Diogo. Portuguese Atherosclerosis Society; Portugal
Fil: Davletov Kairat. Research Health Institute, Al Farabi Kazakh National University; Kazajistán
Fil: Descamps Olivier S. Centres Hospitaliers Universitaires HELORA at La Louvière and University of Mons; Bélgica
Fil: Dwiputra Bambang. Faculty of Medicine, Department of Cardiology and Vascular Medicine, Universitas Indonesia— Harapan Kita National Cardiovascular Center; Indonesia
Fil: Ezhov Marat. National Medical Research Centre of Cardiology of Ministry of Health of the Russian Federation; Rusia
Fil: Groselj Urh. Department of Paediatric Endocrinology, Diabetes and Metabolism, University Medical Centre, University Children’s Hospital Ljubljana; Eslovenia
Fil: Groselj Urh. Faculty of Medicine, University of Ljubljana; Eslovenia
Fil: Harada-Shiba Mariko. Osaka Medical and Pharmaceutical University; Japón
Fil: Holven Kirsten B. National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital; Noruega
Fil: Humphries Steve E. Centre for Cardiovascular Genetics, Institute for Cardiovascular Science, University College London; Reino Unido
Fil: Kayikcioglu Meral. Department of Cardiology, Ege University Medical School; Turquía
Fil: Khovidhunkit Weerapan. Faculty of Medicine, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital; Tailandia
Fil: Lalic Katarina. Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade; Serbia
Fil: Latkovskis Gustavs. Faculty of Medicine, Research Institute of Cardiology and Regenerative Medicine, University of Latvia, Pauls Stradins Clinical University Hospital; Letonia
Fil: Laufs Ulrich. Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig; Alemania
Fil: Liberopoulos Evangelos. First Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistian University of Athens; Grecia
Fil: Lima-Martinez Marcos M. Universidad de Oriente, Núcleo Bolívar; Venezuela
Fil: Maher Vincent. Advanced Lipid Management and Research Centre (ALMAR), Tallaght University Hospital; Irlanda
Fil: Marais A. David. Chemical Pathology, University of Cape Town Health Science Faculty; Sudáfrica
Fil: März Winfried. DACH Society for the Prevention of Heart and Circulatory Diseases; Alemania
Fil: März Winfried. Medical Faculty Mannheim, Department of Internal Medicine, Heidelberg University; Alemania
Fil: März Winfried. Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz; Austria
Fil: März Winfried. Synlab Akademie, Synlab Holding Deutschland; Alemania
Fil: Mirrakhimov Erkin. Kyrgyz State Medical Academy; Kirguistán
Fil: Mirrakhimov Erkin. College of Medicine, Korea University; Corea del Sur
Fil: Miserez André R. Diagene Research Institute and Swiss Society for Familial Forms of Hypercholesterolemia (SSFH); Suiza
Fil: Miserez André R. Faculty of Medicine, University of Basel; Suiza
Fil: Mitchenko Olena. Department of Dyslipidaemia, Institute of Cardiology, National Academy of Medical Sciences; Ucrania
Fil: Nawawi Hapizah. Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA (UiTM); Malasia
Fil: Nordestgaard Børge G. Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen; Dinamarca
Fil: Panayiotou Andrie G. Department of Rehabilitation Sciences, School of Health Sciences, Cyprus University of Technology; Chipre
Fil: Paragh György. Faculty of Medicine, Division of Metabolic Diseases, Department of Internal Medicine, University of Debrecen; Hungría
Fil: Petrulioniene Zaneta. Vilnius University Faculty of Medicine and Vilnius University Hospital Santaros Klinikos; Lituania
Fil: Pojskic Belma. Faculty of Medicine, Cantonal Hospital Zenica, University of Zenica; Bosnia y Herzegovina
Fil: Postadzhiyan Arman. Medical University of Sofia; Bulgaria
Fil: Reda Ashraf. Faculty of Medicine, Department of Cardiology, Menoufia University; Egipto
Fil: Reiner Željko. Department of Internal Medicine, University Hospital Centre Zagreb, and School of Medicine, University of Zagreb; Croacia
Fil: Reyes Ximena. GENYCO Program, Comisión Honoraria para la Salud Cardiovascular; Uruguay
Fil: Sadiq Fouzia. Directorate of Research, Shifa Tameer-e-Millat University; Pakistán
Fil: Sadoh Wilson Ehidiamen. Department of Child Health, University of Benin Teaching Hospital; Nigeria
Fil: Schunkert Heribert. Clinic for Heart and Circulatory Diseases, German Heart Centre Munich, Technical University Munich; Alemania
Fil: Schunkert Heribert. German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance; Alemania
Fil: Shek Aleksandr B. Department of Coronary Heart Disease and Atherosclerosis, Republican Specialized Centre of Cardiology, Ministry of Health of Republic Uzbekistan; Uzbekistán
Fil: Stroes Erik. Department of Vascular Medicine, D3.330, AMC; Países Bajos
Fil: Su Ta-Chen. Departments of Environmental and Occupational Medicine, and Internal Medicine (Cardiology Division), National Taiwan University Hospital; Taiwán
Fil: Subramaniam Tavintharan. Admiralty Medical Centre and Khoo Teck Puat Hospital, Yishun Health; Singapur
Fil: Susekov Andrey V. Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation; Rusia
Fil: Tilney Myra. Lipid Clinic, Mater Dei Hospital; Malta
Fil: Tilney Myra. Faculty of Medicine and Surgery, Department of Medicine, University of Malta; Malta
Fil: Tomlinson Brian. Faculty of Medicine, Macau University of Science and Technology; China
Fil: Truong Thanh Huong. Faculty of Medicine, Phenikaa University, Vietnam Atherosclerosis Society; Vietnam
Fil: Tselepis Alexandros D. Atherothrombosis Research Centre, University of Ioannina; Grecia
Fil: Tybjærg-Hansen Anne. Rigshospitalet, Copenhagen University Hospital, University of Copenhagen; Dinamarca
Fil: Vázquez-Cárdenas Alejandra. Departamento Académico Ciclo de Vida, Universidad Autónoma de Guadalajara; México
Fil: Viigimaa Margus. North Estonia Medical Centre, Tallinn University of Technology; Estonia
Fil: Vohnout Branislav. Department of Diabetology, LF SZU, Institute of Nutrition, FOaZOS, Coordination Centre for Familial Hyperlipidemias, Slovak Medical University in Bratislava; Eslovaquia
Fil: Yamashita Shizuya. Rinku General Medical Centre; Japón
Fil: Ray Kausik K. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unido

Citation

Elshorbagy, A., Vallejo-Vaz, A. J., Barkas, F., Lyons, A. R. M., Stevens, C. A. T., Dharmayat, K. I., Catapano, A. L., Freiberger, T., Hovingh, G. K., Mata, P., Raal, F. J., Santos, R. D., Soran, H., Watts, G. F., Abifadel, M., Aguilar-Salinas, C. A., Alhabib, K. F., Alkhnifsawi, M., Almahmeed, W., Alnouri, F., … Ray, K. K. (2025). Overweight, obesity, and cardiovascular disease in heterozygous familial hypercholesterolaemia: the EAS FH Studies Collaboration registry. European heart journal, 46(12), 1127–1140. https://doi.org/10.1093/eurheartj/ehae791

item.page.issn

1127-1140

item.page.eissn

item.page.isbn

item.page.eisbn

item.page.source

European heart journal, 46(12), 1127–1140.