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Risk factors for cardiovascular disease in heterozygous familial hypercholesterolemia: A systematic review and

Leo E Akioyamen1, Jacques Genest2, Anna Chu1

  • 1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.

Journal of Clinical Lipidology
|December 12, 2018
PubMed

Insights

This study found that age, male sex, hypertension, diabetes, high BMI, smoking, elevated lipoprotein(a), low HDL, and family history of CVD are significant risk factors in heterozygous familial hypercholesterolemia (FH). Targeting these factors can help reduce cardiovascular disease (CVD) risk in FH patients.

Area of Science:

  • Cardiology
  • Genetics
  • Public Health

Background:

  • Conflicting evidence exists regarding cardiovascular disease (CVD) risk factors in heterozygous familial hypercholesterolemia (FH).
  • Understanding these associations is crucial for effective risk management in FH patients.

Purpose of the Study:

  • To systematically review and meta-analyze the association between various CVD risk factors and CVD in individuals with FH.
  • To quantify the impact of identified risk factors on CVD incidence in FH.

Main Methods:

  • Systematic search of major medical databases (MEDLINE, EMBASE, Cochrane Library, PubMed).
  • Inclusion of English-language studies with ≥ 100 participants reporting adjusted associations.
  • Random-effects meta-analysis to calculate pooled odds ratios (ORs) and confidence intervals (CIs).

Main Results:

  • 27 studies (41,831 participants, 6629 CVD events) were included.
  • Significant CVD risk factors in FH: age, male sex, hypertension, diabetes, BMI, smoking, elevated lipoprotein(a), low HDL, and family history of CVD.
  • Hypertension, diabetes, and smoking contributed over 25% of CVD risk; LDL cholesterol > 4.0 mmol/L accounted for one-third of cases.

Conclusions:

  • Several clinical risk factors are independently associated with CVD in FH patients.
  • Targeting modifiable risk factors like smoking, hypertension, and diabetes is recommended.
  • Findings can aid in developing predictive models for risk stratification in FH.
Abstract

Keywords:
Attributable riskCardiovascular diseaseFamilial hypercholesterolemiaMeta-analysisRisk factorsSystematic review

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