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Alves AC, Alonso R, Diaz-Diaz JL, Medeiros AM, Jannes CE, Merchan A, Vasques-Cardenas NA, Cuevas A, Chacra AP, Krieger JE, Arroyo R, Arrieta F, Schreier L, Corral P, Bañares VG, Araujo MB, Bustos P, Asenjo S, Stoll M, Dell'Oca N, Reyes M, Ressia A, Campo R, Magaña-Torres MT, Metha R, Aguilar-Salinas CA, Ceballos-Macias JJ, Morales ÁJR, Mata P, Bourbon M, Santos RD. Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica. Arterioscler Thromb Vasc Biol 2020; 40:2508-2515. [PMID: 32757650 DOI: 10.1161/atvbaha.120.313722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. Approach and Results: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). CONCLUSIONS There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect.
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Affiliation(s)
- Ana Catarina Alves
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile (R. Alonso, A.C.).,Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - José Luís Diaz-Diaz
- Department of Internal Medicine. Hospital Universitario A Coruña, Spain (J.L.D.-D.)
| | - Ana Margarida Medeiros
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Cinthia E Jannes
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Alonso Merchan
- Fundacion Clinica SHAIO, Cardiologia, Bogota, Colombia (A.M.)
| | | | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile (R. Alonso, A.C.)
| | - Ana Paula Chacra
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Jose E Krieger
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.)
| | - Raquel Arroyo
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - Francisco Arrieta
- Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain (F.A.)
| | - Laura Schreier
- Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Aterosclerosis, Argentina (L.S.)
| | - Pablo Corral
- Universidad FASTA, Facultad de Medicina, Cátedra Farmacología e Investigación, Mar del Plata, Argentina (P.C.)
| | - Virginia G Bañares
- Administracion Nacional de Laboratorios e Institutos de Salud "Dr Carlos G. Malbrán'', Centro Nacional de Genética Médica, Departamento de Genética Experimental, Buenos Aires, Argentina (V.G.B.)
| | - Maria B Araujo
- Hospital Nacional de Pediatria ¨Dr JP Garraham¨, Servicio de Nutrición, Buenos Aires, Argentina (M.B.A.)
| | - Paula Bustos
- Facultad de Farmacia (P.B.), Universidad de Concepción, Chile
| | - Sylvia Asenjo
- Facultad de Medicina (S.A.), Universidad de Concepción, Chile
| | - Mario Stoll
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Nicolás Dell'Oca
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Maria Reyes
- Fundación Cardiovascular de Colombia, Cardiologia, Bogotá (R.C.)
| | - Andrés Ressia
- Comision Honoraria de Salud Cardiovascular, Programa GENYCO, Laboratorio de Genética Molecular, Montevideo, Uruguay (M.S., N.D., X.R., A.R.)
| | - Rafael Campo
- Fundación Cardiovascular de Colombia, Cardiologia, Bogotá (R.C.)
| | - Maria T Magaña-Torres
- Instituto Mexicano del Seguro Social, Centro de Investigación Biomédica del Occidente, Guadalajara, México (M.T.M.-T.)
| | - Roopa Metha
- Unidad de Investigación de Enfermedades Metabólicas (R.M., C.A.A.S.)
| | | | - José J Ceballos-Macias
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México. Servicio de Endocrinología, Unidad de Especialidades Médicas, Secretaría de la Defensa Nacional, Mexico (J.J.C.-M.)
| | - Álvaro J Ruiz Morales
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Javerina, Bogotá, Colombia (A.J.R.)
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (R. Alonso, R. Arroyo, P.M.)
| | - Mafalda Bourbon
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Unidade de I&D, Grupo de Investigação Cardiovascular, Lisboa, Portugal (A.C.A., A.M.M., M.B.).,Faculdade de Ciências, Universidade de Lisboa, BioISI-Biosystems & Integrative Sciences Institute, Portugal (A.C.A., A.M.M., M.B.)
| | - Raul D Santos
- Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo, Brazil (C.E.J., A.P.C., J.E.K., R.D.S.).,Hospital Israelita Albert Einstein, Sao Paulo, Brazil (R.D.S.)
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