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Hovland A, Mundal LJ, Veierød MB, Holven KB, Bogsrud MP, Tell GS, Leren TP, Retterstøl K. The risk of various types of cardiovascular diseases in mutation positive familial hypercholesterolemia; a review. Front Genet 2022; 13:1072108. [PMID: 36561318 PMCID: PMC9763610 DOI: 10.3389/fgene.2022.1072108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common, inherited disease characterized by high levels of low-density lipoprotein Cholesterol (LDL-C) from birth. Any diseases associated with increased LDL-C levels including atherosclerotic cardiovascular diseases (ASCVDs) would be expected to be overrepresented among FH patients. There are several clinical scoring systems aiming to diagnose FH, however; most individuals who meet the clinical criteria for a FH diagnosis do not have a mutation causing FH. In this review, we aim to summarize the literature on the risk for the various forms of ASCVD in subjects with a proven FH-mutation (FH+). We searched for studies on FH+ and cardiovascular diseases and also included our and other groups published papers on FH + on a wide range of cardiovascular and other diseases of the heart and vessels. FH + patients are at a markedly increased risk of a broad range of ASCVD. Acute myocardial infarction (AMI) is the most common in absolute numbers, but also aortic valve stenosis is by far associated with the highest excess risk. Per thousand patients, we observed 3.6 incident AMI per year compared to 1.9 incident aortic valve stenosis, however, standardized incidence ratio (SIR) for incident AMI was 2.3 compared to 7.9 for incident aortic valve stenosis. Further, occurrence of ischemic stroke seems not to be associated with increased risk in FH+. Clinicians should be aware of the excess risk of almost all kind of ASCVD in FH+, and the neutral risk of stroke need to be studied further in FH + patients.
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Affiliation(s)
| | - Liv J. Mundal
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Kirsten B. Holven
- Department of Nutrition, University of Oslo, Oslo, Norway,National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Martin Prøven Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Division of Mental, Bergen, Norway
| | - Trond P. Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway,Department of Nutrition, University of Oslo, Oslo, Norway,*Correspondence: Kjetil Retterstøl,
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2
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Kjærgaard KA, Harborg S, Jensen HK, Borgquist S. Long-term cancer risk in heterozygous familial hypercholesterolemia relatives: a 25-year cohort study. Lipids Health Dis 2022; 21:56. [PMID: 35780163 PMCID: PMC9250710 DOI: 10.1186/s12944-022-01666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Heterozygous familial hypercholesterolemia (HeFH) due to low-density lipoprotein receptor (LDLR) mutations predisposes patients to highly elevated levels of cholesterol, and patients are at increased risk of adverse cardiovascular events and other morbidities. Whether the LDLR mutation and high cholesterol levels affect the risk of cancer remains unknown. The purpose of the present study was to assess the long-term cancer risk in HeFH relatives. Methods Study participants were identified by cascade screening during 1992–1994. A comparison cohort was matched 10:1 to the relatives from the Danish general population based on birth year, gender and address. All participants were followed until a cancer diagnosis, migration, death, or end of follow-up as of December 31, 2019. The primary endpoint was any incident cancer diagnosis. Results In total, we included 221 relatives with a median age of 37 years (interquartile range: 27–53 years). A total of 117 (53%) of the relatives carried a LDLR gene mutation. The crude hazard ratio of our primary endpoint did not reveal any differences in cancer incidence in mutation-carrying relatives compared with the general population cohort (1.18; 95% CI, 0.81–1.71). Nonmutation-carrying relatives however had a lower cancer incidence than the general population (0.45: 95% CI, 0.26–0.80). Thus, the risk among mutation-carrying HeFH relatives compared with nonmutation-carrying HeFH relatives was increased (HR: 2.39; 95% CI, 1.24–4.61). Conclusion In Denmark, LDLR mutation-carrying HeFH relatives did not have a different cancer risk than the general population. In contrast, nonmutation-carrying relatives had a lower risk of cancer.
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Affiliation(s)
- Kasper Aalbæk Kjærgaard
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Sixten Harborg
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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3
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Ramos R, Masana L, Comas-Cufí M, García-Gil M, Martí-Lluch R, Ponjoan A, Plana N, Alves-Cabratosa L, Marrugat J, Elosua R, Dégano IR, Gomez-Marcos MA, Zamora A. Derivation and validation of SIDIAP-FHP score: A new risk model predicting cardiovascular disease in familial hypercholesterolemia phenotype. Atherosclerosis 2019; 292:42-51. [PMID: 31759248 DOI: 10.1016/j.atherosclerosis.2019.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Assessment of individual cardiovascular risk, distinguishing primary and secondary prevention, would improve the clinical management of the population with familial hypercholesterolemia. We aimed to develop and validate two risk functions to predict incident and recurrent atherosclerotic cardiovascular disease (ASCVD) in a primary care-based population with familial hypercholesterolemia phenotype (FHP), and to compare their predictive capacity with that of the SpAnish Familial hypErcHolEsterolemiA cohoRT (SAFEHEART) risk equation (SAFEHEART-RE). METHODS Data from the Catalan primary care system database (SIDIAP) of patients ≥18 years old with FHP in 2006-2013 were used to develop and validate two risk functions to predict incident and recurrent ASCVD. A validation dataset was also used to compare the model predictive capacity to that of SAFEHEART-RE. RESULTS The new model (SIDIAP-FHP) included age, diabetes, smoking, sex (male), hypertension, and baseline low-density lipoprotein cholesterol in the primary prevention cohort and age, diabetes, smoking, and disease characteristics (progressive, recent, polyvascular, or included myocardial infarction) in the secondary prevention cohort. The models demonstrated a fair fit: C-Statistic: 0.71 (95%CI:0.68-0.75) in primary prevention and 0.65 (95%CI:0.60-0.70) in secondary prevention (higher than that of SAFEHEART-RE: 0.64 [95%CI:0.60-0.68] and 0.55 [95%CI:0.51-0.59], respectively; both p < 0.01). The Brier scores obtained with the SIDIAP-FHP score were significantly lower than that obtained with SAFEHEART-RE in both the primary and secondary prevention cohorts. CONCLUSIONS The SIDIAP-FHP score provides accurate ASCVD risk estimates for primary and secondary prevention in the FHP population, with better predictive capacity than that of SAFEHEART-RE in this general population, especially in persons with previous ASCVD.
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Affiliation(s)
- Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain.
| | - Luís Masana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Marc Comas-Cufí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Ruth Martí-Lluch
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Anna Ponjoan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Núria Plana
- Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Research Unit, "Sant Joan" University Hospital, Internal Medicine Department, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Lia Alves-Cabratosa
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Catalonia, Spain; ISV Research Group. Research Unit in Primary Care, Primary Care Services, Girona. Catalan Institute of Health (ICS), Catalonia, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group, Municipal Institute for Medical Research (IMIM), Barcelona, Spain; CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain
| | - Roberto Elosua
- CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain; Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - Irene R Dégano
- Registre Gironí del COR (REGICOR) Group, Municipal Institute for Medical Research (IMIM), Barcelona, Spain; CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Catalonia, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Mauel A Gomez-Marcos
- . Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, The Alamedilla Health Center, Salamanca, Spain; Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Zamora
- Department of Medical Sciences, School of Medicine, University of Girona, Spain; Xarxa de Unitats de Lipids de Catalunya (XULA), Girona, Spain; Lipids and Arteriosclerosis Unit, Blanes Hospital, Girona, Spain; Laboratory of Translational Medicine (Translab), School of Medicine, University of Girona, Spain
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Cao YX, Zhou BY, Sun D, Li S, Guo YL, Zhu CG, Wu NQ, Gao Y, Xu RX, Liu G, Dong Q, Li JJ. Differences in phenotype, genotype and cardiovascular events between patients with probable and definite heterozygous familial hypercholesterolemia. Per Med 2019; 16:467-478. [PMID: 31691639 DOI: 10.2217/pme-2018-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To investigated the potential differences between probable and definite heterozygous familial hypercholesterolemia (HeFH) patients diagnosed by Dutch Lipid Clinic Network criteria. Methods: Clinical characteristics, lipid profile, severity of coronary artery stenosis and gene mutations were compared. Kaplan-Meier curve was performed to evaluate the cardiovascular events. Results: Overall, 325 participants were included and divided into two groups: probable (n = 233) and definite HeFH (n = 92). Definite HeFH patients had higher low-density lipoprotein cholesterol (LDL-C), oxidized-LDL and proprotein convertase subtilisin/kexin 9 levels, and higher prevalence of tendon xanthomas. The incidence of genetic mutations was statistically higher in definite HeFH than probable HeFH patients. The coronary stenosis calculated by Gensini score was statistically severer in definite HeFH patients. The best LDL-C threshold for predicting mutations was 5.14 mmol/l. Definite HeFH had lower event-free survival rates. Conclusion: Definite HeFH patients had higher severity of phenotype and genotype, and higher risk of cardiovascular events.
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Affiliation(s)
- Ye-Xuan Cao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Bing-Yang Zhou
- Department of Cardiology, Tianjin Chest Hospital, Tianjin Institute of Cardiovascular Diseases, Tianjin 300222, China
| | - Di Sun
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Ying Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Geng Liu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Qian Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
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5
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Chiva-Blanch G, Padró T, Alonso R, Crespo J, Perez de Isla L, Mata P, Badimon L. Liquid Biopsy of Extracellular Microvesicles Maps Coronary Calcification and Atherosclerotic Plaque in Asymptomatic Patients With Familial Hypercholesterolemia. Arterioscler Thromb Vasc Biol 2019; 39:945-955. [DOI: 10.1161/atvbaha.118.312414] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Heterozygous familial hypercholesterolemia (FH) is the most common genetic disorder associated with premature atherosclerotic cardiovascular disease. Circulating microvesicles (cMV) are released when cells are activated. We investigated whether cMV could provide information on coronary calcification and atherosclerosis in FH patients.
Approach and Results—
Eighty-two patients (mean of 44±9 years old) with molecular diagnosis of heterozygous FH and asymptomatic cardiovascular disease were investigated. Atherosclerotic plaque characterization was performed by computed tomography angiography, and Agatston coronary calcium score and plaque composition sum were calculated. cMV were quantified by flow cytometry using AV (annexin V) and cell surface-specific antibodies. Of the 82 FH patients, 48 presented atherosclerotic plaque. Patients with atherosclerosis were men and older in a higher percentage than patients without atherosclerotic plaque. FH patients with atherosclerotic plaque showed higher levels of total AV
+
cMV, cMV AV
+
from platelet origin, from granulocytes and neutrophils, and cMV AV
+/−
from endothelial cells than FH-patients without atherosclerotic plaque. Plaque composition sum correlated with platelet- and endothelial-derived cMV, and Agatston coronary calcium score correlated with granulocyte-, platelet-, and endothelial-derived cMV. Receiver operating characteristic curve analyses indicated that the cluster of platelet-, granulocyte-, neutrophil, and endothelial-derived cMV considered together, added significant predictive value to the specific SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) risk equation for plaque presence (area under the curve=0.866, 95% CI, 0.775–0.958;
P
<0.0001,
P
=0.030 for the increment of the area under the curve).
Conclusions—
Endothelial-, granulocyte-, neutrophil- and platelet-derived cMV discriminate and map coronary atherosclerotic plaque and calcification in asymptomatic patients with FH. Liquid biopsy of cMV may be a surrogate biomarker of coronary atherosclerotic plaque burden in FH patients.
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Affiliation(s)
- Gemma Chiva-Blanch
- From the Cardiovascular Science Institute – ICCC; IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain (G.C.-B., T.P., J.C., L.B.)
| | - Teresa Padró
- From the Cardiovascular Science Institute – ICCC; IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain (G.C.-B., T.P., J.C., L.B.)
- CiberCV, Institute Carlos III, Madrid, Spain (T.P., L.B.)
| | - Rodrigo Alonso
- Nutrition Department, Clínica las Condes, Santiago de Chile, Chile (R.A.)
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R.A., L.P.d.I., P.M.)
| | - Javier Crespo
- From the Cardiovascular Science Institute – ICCC; IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain (G.C.-B., T.P., J.C., L.B.)
| | - Leopoldo Perez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R.A., L.P.d.I., P.M.)
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.)
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R.A., L.P.d.I., P.M.)
| | - Lina Badimon
- From the Cardiovascular Science Institute – ICCC; IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain (G.C.-B., T.P., J.C., L.B.)
- CiberCV, Institute Carlos III, Madrid, Spain (T.P., L.B.)
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6
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Perez-Calahorra S, Laclaustra M, Marco-Benedí V, Lamiquiz-Moneo I, Pedro-Botet J, Plana N, Sanchez-Hernandez RM, Amor AJ, Almagro F, Fuentes F, Suarez-Tembra M, Civeira F. Effect of lipid-lowering treatment in cardiovascular disease prevalence in familial hypercholesterolemia. Atherosclerosis 2019; 284:245-252. [PMID: 30827715 DOI: 10.1016/j.atherosclerosis.2019.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The impact on heterozygous familial hypercholesterolemia (HeFH) health led by high-intensity lipid-lowering therapy (HILLT) is unknown, and the question remains if there is still an unacceptably high residual risk to justify treatment with new lipid-lowering drugs. METHODS This observational, retrospective, multicenter, national study in Spain, whose information was obtained from a national dyslipemia registry, was designed to establish the current prevalence of cardiovascular disease (CVD) in HeFH and to define the impact of HILLT on CVD in this population. Odds were estimated using several logistic regression models with progressive adjustment. RESULTS 1958 HeFH, mean age 49.3 ± 14.3 years, were included in the analysis. At inclusion in the registry, 295 patients (15.1%) had suffered CVD and 164 (55.6%) had suffered the first event before the onset lipid-lowering treatment. Exposition to treatment associated more than ten times lower odds for CVD than in subjects naïve to treatment (OR 0.085, 95% CI 0.063-0.114, p < 0.001). A first CVD event after a mean treatment period of 9.1 ± 7.2 years occurred in 131 out of 1615 (8.1%) HeFH subjects, and 115 (87.8%) of them were on HILLT. CONCLUSIONS Current prevalence of CVD among HeFH is one third of that reported before the statins era. Early initiation and prolonged lipid-lowering treatment was associated with a reduction in CVD. New cases of CVD, in spite of HILLT, appeared mostly among patients accumulating risk factors and probably they may be considered for further lipid-lowering drugs.
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Affiliation(s)
- Sofía Perez-Calahorra
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Martín Laclaustra
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Victoria Marco-Benedí
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Itziar Lamiquiz-Moneo
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain
| | - Juan Pedro-Botet
- Lipid and Vascular Risk Unit, Department of Endocrinology and Nutrition, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolism, Hospital Universitari Sant Joan, Institut d'Investigación Sanitaria Pere Virgili (IISPV), CIBERDEM, Reus, Tarragona, Spain
| | - Rosa M Sanchez-Hernandez
- Lipid Unit, Endocrinology Department, Hospital Universitario Insular de Gran Canaria, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de, Gran Canaria, Spain
| | - Antonio J Amor
- Lipid Unit, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, CIBEROBN, Barcelona, Spain
| | - Fátima Almagro
- Lipid Unit, Hospital Universitario Donostia, San Sebastián, Spain
| | - Francisco Fuentes
- Lipid Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, CIBEROBN, Universidad de Córdoba, Spain
| | | | - Fernando Civeira
- Lipid Unit. Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain.
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7
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Hovland A, Mundal LJ, Igland J, Veierød MB, Holven KB, Bogsrud MP, Tell GS, Leren TP, Retterstøl K. Risk of Ischemic Stroke and Total Cerebrovascular Disease in Familial Hypercholesterolemia: A Register Study From Norway. Stroke 2019; 50:172-174. [PMID: 30580708 DOI: 10.1161/strokeaha.118.023456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Purpose- Familial hypercholesterolemia (FH) is a common autosomal dominant disease leading to increased level of serum LDL (low-density lipoprotein) cholesterol and risk of coronary heart disease. Whether FH increases the risk of cerebrovascular disease, including ischemic stroke, is debated. Accordingly, we studied the incidence of cerebrovascular disease in a cohort of people with genetically verified FH compared with the entire Norwegian population and examined whether people in this cohort with previous cohort had increased risk of cerebrovascular disease. Methods- Incidence rates of hospitalization for cerebrovascular disease (among 3144 people with FH) and ischemic stroke (among 3166 people with FH) were estimated by linkage of FH people to Cardiovascular Disease in Norway-a nationwide database of cardiovascular disease hospitalizations (2001-2009). We calculated standardized incidence ratios and used Cox regression to estimate hazard ratios. Results- A total of 46 cases (19 women and 27 men) of cerebrovascular disease were observed in the cohort of people with FH, with no increased risk of cerebrovascular disease compared with the general population (standardized incidence ratio, 1.0; 95% CI, 0.8-1.4). Total number of ischemic strokes in the cohort of people with FH was 26 (9 women and 17 men), with no increased risk compared with the general population (standardized incidence ratio, 1.0; 95% CI, 0.7-1.5). Prior coronary heart disease significantly increased cerebrovascular disease risk in women (hazard ratio, 3.29; 95% CI, 1.20-9.00) but not in men (hazard ratio, 1.03; 95% CI, 0.45-2.37; Pinteraction=0.04). Conclusions- In a large cohort of genetically verified FH, risks of cerebrovascular disease and ischemic stroke were not increased compared with the total Norwegian population.
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Affiliation(s)
- Anders Hovland
- From the Division of Internal Medicine, Nordland Hospital, Bodø, Norway (A.H.)
- Department of Clinical Medicine, University of Tromsø, Norway (A.H.)
| | - Liv J Mundal
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway (L.J.M., K.R.)
| | - Jannicke Igland
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen (J.I.)
- Department of Global Public Health and Primary Care, University of Bergen, Norway, (J.I., G.S.T.)
| | - Marit B Veierød
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology (M.B.V.), University of Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition (K.B.H., K.R.), University of Oslo, Norway
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway (K.B.H., M.P.B.)
| | - Martin Prøven Bogsrud
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway (K.B.H., M.P.B.)
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway, (J.I., G.S.T.)
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway (G.S.T.)
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital Ullevål, Norway (T.P.L.)
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway (L.J.M., K.R.)
- Department of Nutrition (K.B.H., K.R.), University of Oslo, Norway
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8
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Mata P, Alonso R, Pérez de Isla L. Atherosclerotic cardiovascular disease risk assessment in familial hypercholesterolemia: does one size fit all? Curr Opin Lipidol 2018; 29:445-452. [PMID: 30382952 DOI: 10.1097/mol.0000000000000553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia is a frequent genetic disease associated with lifelong elevation of LDL-cholesterol and premature atherosclerotic cardiovascular disease (ASCVD). Statins are the cornerstone of treatment. However, with the introduction of novel LDL-cholesterol-lowering therapies, it is necessary to identify familial hypercholesterolemia patients presenting a significantly high residual ASCVD risk. The aim of this review is to provide an update on the recent literature concerning cardiovascular risk stratification including the role of coronary imaging. RECENT FINDINGS Several factors have shown to be independent predictors of ASCVD in familial hypercholesterolemia. These include clinical scores with cardiovascular risk factors, coronary imaging and novel protein biomarkers. However, the recent introduction of the SAFEHEART risk-equation (SAFEHEART-RE) could allow a more accurate ASCVD risk prediction in familial hypercholesterolemia. SUMMARY This article highlights the SAFEHEART-RE as a model to predict incident ASCVD in familial hypercholesterolemia. This equation is a simple and widely applicable tool for use in every clinical setting. Furthermore, coronary atherosclerosis assessed by coronary computed-tomographic angiography (coronary-CTA) is independently associated to the cardiovascular risk estimated according to the SAFEHEART-RE. This equation, as well as coronary-CTA and new biomarkers, could increase individual ASCVD risk stratification and could improve the efficiency and the use of new lipid-lowering therapies in familial hypercholesterolemia.
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Affiliation(s)
- Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Nutrition Department, Clínica las Condes, Santiago de Chile, Chile
| | - Leopoldo Pérez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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Lundberg GP, Mehta LS, Volgman AS. Specialized Care for Women: the Impact of Women's Heart Centers. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:76. [PMID: 30091012 DOI: 10.1007/s11936-018-0656-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF THE REVIEW Cardiovascular disease (CVD) has been and remains the leading cause of mortality in women in the United States. For decades, more women died every year of CVD compared to men. Heart centers for women (HCW) are developed in response to the need for greater patient and physician awareness of CVD in women and to conduct sex-specific research in women. Today, many HCW provide multispecialty and focused areas of cardiovascular care for women. HCW provide their female patients with expertise over the many stages of a woman's life. And HCW partner with national organizations to advance research and education through specialized and focused care for women. The purpose of this review is to review the historical development of heart centers for women and discuss the types of care they provide for women. RECENT FINDINGS Mortality rates from cardiovascular disease in women are finally reaching the levels of men after decades of focus on awareness, prevention, and evidence-based guideline-directed care for women. Heart centers for women have evolved to provide subspecialty and comprehensive care for women that includes education and research. Heart centers for women are partnering with many other disease-based and patient advocacy organizations to provide care for all women at all stages of life. Alarmingly, there has been increasing CVD mortality in both men and women recently.
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Affiliation(s)
- Gina P Lundberg
- Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Laxmi S Mehta
- Women's Cardiovascular Program, The Ohio State University, Columbus, OH, USA
| | - Annabelle S Volgman
- Rush Heart Center for Women, Rush University Medical Center, Chicago, IL, USA
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Civeira F, Pocoví M. Familial hypercholesterolemia in pediatric patients. The success begins here. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:179-180. [PMID: 29986810 DOI: 10.1016/j.arteri.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Fernando Civeira
- Instituto De Investigación Sanitaria Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España.
| | - Miguel Pocoví
- Instituto De Investigación Sanitaria Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
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Ascher S, Reinhardt C. The gut microbiota: An emerging risk factor for cardiovascular and cerebrovascular disease. Eur J Immunol 2018; 48:564-575. [DOI: 10.1002/eji.201646879] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/24/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Stefanie Ascher
- Center for Thrombosis and Hemostasis; University Medical Center Mainz, Johannes Gutenberg University of Mainz; Mainz Germany
| | - Christoph Reinhardt
- Center for Thrombosis and Hemostasis; University Medical Center Mainz, Johannes Gutenberg University of Mainz; Mainz Germany
- German Center for Cardiovascular Research (DZHK); Partner Site RheinMain; Mainz Germany
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