2026-03-272026-03-27Elshorbagy, 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/ehae7911127-1140https://dspace.ufasta.edu.ar/handle/123456789/87987Background 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 UnidoFil: Elshorbagy Amany. Department of Physiology, Faculty of Medicine, University of Alexandria; EgiptoFil: 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 UnidoFil: Vallejo-Vaz Antonio J. Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC; EspañaFil: Vallejo-Vaz Antonio J. Faculty of Medicine, Department of Medicine, University of Seville; EspañaFil: Vallejo-Vaz Antonio J. Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Instituto de Salud Carlos III; EspañaFil: Barkas Fotios. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino UnidoFil: Barkas Fotios. Faculty of Medicine, Department of Internal Medicine, School of Health Sciences, University of Ioannina; GreciaFil: 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 UnidoFil: 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 UnidoFil: Dharmayat Kanika I. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino UnidoFil: Catapano Alberico L. Department of Pharmacological and Biomolecular Sciences, University of Milan; ItaliaFil: Catapano Alberico L. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica; ItaliaFil: Freiberger Tomas. Centre for Cardiovascular Surgery and Transplantation, and Medical Faculty, Masaryk University; República ChecaFil: Freiberger Tomas. CarDia—National Institute for Metabolic and Cardiovascular Disease Research; República ChecaFil: Hovingh G. Kees. Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam; Países BajosFil: Hovingh G. Kees. Novo Nordisk; DinamarcaFil: Mata Pedro. Fundación Hipercolesterolemia Familiar; EspañaFil: Raal Frederick J. Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand; SudáfricaFil: Santos Raul D. Heart Institute (InCor), University of São Paulo and Hospital Israelita Albert Einstein; BrasilFil: Soran Handrean. Manchester University NHS Foundation Trust; Reino UnidoFil: Watts Gerald F. Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia; AustraliaFil: Watts Gerald F. Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital; AustraliaFil: Abifadel Marianne. Faculty of Pharmacy, Laboratory of Biochemistry and Molecular Therapeutics, Saint Joseph University; LíbanoFil: Aguilar-Salinas Carlos A. Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; MéxicoFil: Aguilar-Salinas Carlos A. Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud; MéxicoFil: Alhabib Khalid F. Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University Medical City, King Saud University; Arabia SauditaFil: Alkhnifsawi Mutaz. College of Pharmacy, University of Al Qadisiyah; IrakFil: Alkhnifsawi Mutaz. College of Medicine, University of Warith Al-Anbiyaa; IrakFil: Almahmeed Wael. Cleveland Clinic Abu Dhabi, Heart and Vascular Institute; Emiratos Árabes UnidosFil: Alnouri Fahad. Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre; Arabia SauditaFil: Alonso Rodrigo. Centre for Advanced Metabolic Medicine and Nutrition; ChileFil: Al-Rasadi Khalid. Department of Biochemistry, College of Medicine and Health Science and Medical Research Centre, Sultan Qaboos University; OmánFil: Al-Sarraf Ahmad. Sabah Al Ahmad Cardiac Centre; KuwaitFil: Arca Marcello. Department of Translational and Precision Medicine, Sapienza University of Rome; ItaliaFil: Ashavaid Tester F. Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre Mahim; IndiaFil: Averna Maurizio. Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo; ItaliaFil: Averna Maurizio. Istituto di Biofisica, Consiglio Nazionale delle Ricerche; ItaliaFil: Banach Maciej. Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL); PoloniaFil: Banach Maciej. Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI); PoloniaFil: Banach Maciej. Cardiovascular Research Centre, University of Zielona Gora; PoloniaFil: Becker Marianne. Department of Pediatric Endocrinology and Diabetology, Centre hospitalier de Luxembourg; LuxemburgoFil: Binder Christoph J. Department of Laboratory Medicine, Medical University of Vienna; AustriaFil: 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; PortugalFil: Bourbon Mafalda. Faculty of Sciences, Biosystems and Integrative Sciences Institute (BioISI), University of Lisbon; PortugalFil: Brunham Liam R. Departments of Medicine and Medical Genetics, Centre for Heart Lung Innovation, The University of British Columbia; CanadáFil: Chlebus Krzysztof. 1st Department of Cardiology Medical University of Gdańsk, National Centre of Familial Hypercholesterolaemia in Gdańsk; PoloniaFil: Corral Pablo. Universidad FASTA. Facultad de Ciencias Médicas; ArgentinaFil: Cruz Diogo. Portuguese Atherosclerosis Society; PortugalFil: Davletov Kairat. Research Health Institute, Al Farabi Kazakh National University; KazajistánFil: Descamps Olivier S. Centres Hospitaliers Universitaires HELORA at La Louvière and University of Mons; BélgicaFil: Dwiputra Bambang. Faculty of Medicine, Department of Cardiology and Vascular Medicine, Universitas Indonesia— Harapan Kita National Cardiovascular Center; IndonesiaFil: Ezhov Marat. National Medical Research Centre of Cardiology of Ministry of Health of the Russian Federation; RusiaFil: Groselj Urh. Department of Paediatric Endocrinology, Diabetes and Metabolism, University Medical Centre, University Children’s Hospital Ljubljana; EsloveniaFil: Groselj Urh. Faculty of Medicine, University of Ljubljana; EsloveniaFil: Harada-Shiba Mariko. Osaka Medical and Pharmaceutical University; JapónFil: Holven Kirsten B. National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital; NoruegaFil: Humphries Steve E. Centre for Cardiovascular Genetics, Institute for Cardiovascular Science, University College London; Reino UnidoFil: Kayikcioglu Meral. Department of Cardiology, Ege University Medical School; TurquíaFil: Khovidhunkit Weerapan. Faculty of Medicine, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital; TailandiaFil: Lalic Katarina. Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade; SerbiaFil: Latkovskis Gustavs. Faculty of Medicine, Research Institute of Cardiology and Regenerative Medicine, University of Latvia, Pauls Stradins Clinical University Hospital; LetoniaFil: Laufs Ulrich. Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig; AlemaniaFil: Liberopoulos Evangelos. First Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistian University of Athens; GreciaFil: Lima-Martinez Marcos M. Universidad de Oriente, Núcleo Bolívar; VenezuelaFil: Maher Vincent. Advanced Lipid Management and Research Centre (ALMAR), Tallaght University Hospital; IrlandaFil: Marais A. David. Chemical Pathology, University of Cape Town Health Science Faculty; SudáfricaFil: März Winfried. DACH Society for the Prevention of Heart and Circulatory Diseases; AlemaniaFil: März Winfried. Medical Faculty Mannheim, Department of Internal Medicine, Heidelberg University; AlemaniaFil: März Winfried. Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz; AustriaFil: März Winfried. Synlab Akademie, Synlab Holding Deutschland; AlemaniaFil: Mirrakhimov Erkin. Kyrgyz State Medical Academy; KirguistánFil: Mirrakhimov Erkin. College of Medicine, Korea University; Corea del SurFil: Miserez André R. Diagene Research Institute and Swiss Society for Familial Forms of Hypercholesterolemia (SSFH); SuizaFil: Miserez André R. Faculty of Medicine, University of Basel; SuizaFil: Mitchenko Olena. Department of Dyslipidaemia, Institute of Cardiology, National Academy of Medical Sciences; UcraniaFil: Nawawi Hapizah. Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA (UiTM); MalasiaFil: Nordestgaard Børge G. Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen; DinamarcaFil: Panayiotou Andrie G. Department of Rehabilitation Sciences, School of Health Sciences, Cyprus University of Technology; ChipreFil: Paragh György. Faculty of Medicine, Division of Metabolic Diseases, Department of Internal Medicine, University of Debrecen; HungríaFil: Petrulioniene Zaneta. Vilnius University Faculty of Medicine and Vilnius University Hospital Santaros Klinikos; LituaniaFil: Pojskic Belma. Faculty of Medicine, Cantonal Hospital Zenica, University of Zenica; Bosnia y HerzegovinaFil: Postadzhiyan Arman. Medical University of Sofia; BulgariaFil: Reda Ashraf. Faculty of Medicine, Department of Cardiology, Menoufia University; EgiptoFil: Reiner Željko. Department of Internal Medicine, University Hospital Centre Zagreb, and School of Medicine, University of Zagreb; CroaciaFil: Reyes Ximena. GENYCO Program, Comisión Honoraria para la Salud Cardiovascular; UruguayFil: Sadiq Fouzia. Directorate of Research, Shifa Tameer-e-Millat University; PakistánFil: Sadoh Wilson Ehidiamen. Department of Child Health, University of Benin Teaching Hospital; NigeriaFil: Schunkert Heribert. Clinic for Heart and Circulatory Diseases, German Heart Centre Munich, Technical University Munich; AlemaniaFil: Schunkert Heribert. German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance; AlemaniaFil: Shek Aleksandr B. Department of Coronary Heart Disease and Atherosclerosis, Republican Specialized Centre of Cardiology, Ministry of Health of Republic Uzbekistan; UzbekistánFil: Stroes Erik. Department of Vascular Medicine, D3.330, AMC; Países BajosFil: Su Ta-Chen. Departments of Environmental and Occupational Medicine, and Internal Medicine (Cardiology Division), National Taiwan University Hospital; TaiwánFil: Subramaniam Tavintharan. Admiralty Medical Centre and Khoo Teck Puat Hospital, Yishun Health; SingapurFil: Susekov Andrey V. Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation; RusiaFil: Tilney Myra. Lipid Clinic, Mater Dei Hospital; MaltaFil: Tilney Myra. Faculty of Medicine and Surgery, Department of Medicine, University of Malta; MaltaFil: Tomlinson Brian. Faculty of Medicine, Macau University of Science and Technology; ChinaFil: Truong Thanh Huong. Faculty of Medicine, Phenikaa University, Vietnam Atherosclerosis Society; VietnamFil: Tselepis Alexandros D. Atherothrombosis Research Centre, University of Ioannina; GreciaFil: Tybjærg-Hansen Anne. Rigshospitalet, Copenhagen University Hospital, University of Copenhagen; DinamarcaFil: Vázquez-Cárdenas Alejandra. Departamento Académico Ciclo de Vida, Universidad Autónoma de Guadalajara; MéxicoFil: Viigimaa Margus. North Estonia Medical Centre, Tallinn University of Technology; EstoniaFil: Vohnout Branislav. Department of Diabetology, LF SZU, Institute of Nutrition, FOaZOS, Coordination Centre for Familial Hyperlipidemias, Slovak Medical University in Bratislava; EslovaquiaFil: Yamashita Shizuya. Rinku General Medical Centre; JapónFil: Ray Kausik K. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London; Reino Unidoapplication/pdfinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licences/by-nc-nd/3.0/deed.es_ARDislipidemiaObesidadResistencia a la insulinaAterosclerosisinfo:eu-repo/semanticspte/article