TY - JOUR
T1 - Overweight, obesity, and cardiovascular disease in heterozygous familial hypercholesterolaemia
T2 - the EAS FH Studies Collaboration registry
AU - on behalf of the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)
AU - Elshorbagy, Amany
AU - Vallejo-Vaz, Antonio J.
AU - Barkas, Fotios
AU - Lyons, Alexander R.M.
AU - Stevens, Christophe A.T.
AU - Dharmayat, Kanika I.
AU - Catapano, Alberico L.
AU - Freiberger, Tomas
AU - Hovingh, G. Kees
AU - Mata, Pedro
AU - Raal, Frederick J.
AU - Santos, Raul D.
AU - Soran, Handrean
AU - Watts, Gerald F.
AU - Abifadel, Marianne
AU - Aguilar-Salinas, Carlos A.
AU - Alhabib, Khalid F.
AU - Alkhnifsawi, Mutaz
AU - Almahmeed, Wael
AU - Alnouri, Fahad
AU - Alonso, Rodrigo
AU - Al-Rasadi, Khalid
AU - Al-Sarraf, Ahmad
AU - Arca, Marcello
AU - Ashavaid, Tester F.
AU - Averna, Maurizio
AU - Banach, Maciej
AU - Becker, Marianne
AU - Binder, Christoph J.
AU - Bourbon, Mafalda
AU - Brunham, Liam R.
AU - Chlebus, Krzysztof
AU - Corral, Pablo
AU - Cruz, Diogo
AU - Davletov, Kairat
AU - Descamps, Olivier S.
AU - Dwiputra, Bambang
AU - Ezhov, Marat
AU - Groselj, Urh
AU - Harada-Shiba, Mariko
AU - Holven, Kirsten B.
AU - Humphries, Steve E.
AU - Kayikcioglu, Meral
AU - Khovidhunkit, Weerapan
AU - Lalic, Katarina
AU - Latkovskis, Gustavs
AU - Laufs, Ulrich
AU - Liberopoulos, Evangelos
AU - Lima-Martinez, Marcos M.
AU - Maher, Vincent
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/3/21
Y1 - 2025/3/21
N2 - Background and Overweight and obesity are modifiable risk factors for atherosclerotic cardiovascular disease (ASCVD) in the general popuAims lation, 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.
AB - Background and Overweight and obesity are modifiable risk factors for atherosclerotic cardiovascular disease (ASCVD) in the general popuAims lation, 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.
KW - Adiposity
KW - Atherosclerosis
KW - Dyslipidaemia
KW - Insulin resistance
UR - https://www.scopus.com/pages/publications/105002060375
U2 - 10.1093/eurheartj/ehae791
DO - 10.1093/eurheartj/ehae791
M3 - Article
C2 - 39801189
AN - SCOPUS:105002060375
SN - 0195-668X
VL - 46
SP - 1127
EP - 1140
JO - European Heart Journal
JF - European Heart Journal
IS - 12
ER -
SDG 3 Good Health and Well-being