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Pérez de Isla L, Alonso R, Mata N, Fernández-Pérez C, Muñiz O, Díaz-Díaz JL, Saltijeral A, Fuentes-Jiménez F, de Andrés R, Zambón D, Piedecausa M, Cepeda JM, Mauri M, Galiana J, Brea Á, Sanchez Muñoz-Torrero JF, Padró T, Argueso R, Miramontes-González JP, Badimón L, Santos RD, Watts GF, Mata P. Predicting Cardiovascular Events in Familial Hypercholesterolemia: The SAFEHEART Registry (Spanish Familial Hypercholesterolemia Cohort Study). Circulation 2017; 135:2133-2144. [PMID: 28275165 DOI: 10.1161/circulationaha.116.024541] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although risk factors for atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolemia (FH) have been described, models for predicting incident ASCVD have not been reported. Our aim was to use the SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study) to define key risk factors for predicting incident ASCVD in patients with FH. METHODS SAFEHEART is a multicenter, nationwide, long-term prospective cohort study of a molecularly defined population with FH with or without previous ASCVD. Analyses to define risk factors and to build a risk prediction equation were developed, and the risk prediction equation was tested for its ability to discriminate patients who experience incident ASCVD from those who did not over time. RESULTS We recruited 2404 adult patients with FH who were followed up for a mean of 5.5 years (SD, 3.2 years), during which 12 (0.5%) and 122 (5.1%) suffered fatal and nonfatal incident ASCVD, respectively. Age, male sex, history of previous ASCVD, high blood pressure, increased body mass index, active smoking, and low-density lipoprotein cholesterol and lipoprotein(a) levels were independent predictors of incident ASCVD from which a risk equation with a Harrell C index of 0.85 was derived. The bootstrap resampling (100 randomized samples) of the original set for internal validation showed a degree of overoptimism of 0.003. Individual risk was estimated for each person without an established diagnosis of ASCVD before enrollment in the registry by use of the SAFEHEART risk equation, the modified Framingham risk equation, and the American College of Cardiology/American Heart Association ASCVD Pooled Cohort Risk Equations. The Harrell C index for these models was 0.81, 0.78, and 0.8, respectively, and differences between the SAFEHEART risk equation and the other 2 were significant (P=0.023 and P=0.045). CONCLUSIONS The risk of incident ASCVD may be estimated in patients with FH with simple clinical predictors. This finding may improve risk stratification and could be used to guide therapy in patients with FH. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Rodrigo Alonso
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Nelva Mata
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Cristina Fernández-Pérez
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Ovidio Muñiz
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José Luis Díaz-Díaz
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Adriana Saltijeral
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Francisco Fuentes-Jiménez
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Raimundo de Andrés
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Daniel Zambón
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Mar Piedecausa
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José María Cepeda
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Marta Mauri
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Jesús Galiana
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Ángel Brea
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Juan Francisco Sanchez Muñoz-Torrero
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Teresa Padró
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Rosa Argueso
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José Pablo Miramontes-González
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Lina Badimón
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Raúl D Santos
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Gerald F Watts
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Pedro Mata
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.).
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Pérez de Isla L, Alonso R, Mata N, Saltijeral A, Muñiz O, Rubio-Marin P, Diaz-Diaz JL, Fuentes F, de Andrés R, Zambón D, Galiana J, Piedecausa M, Aguado R, Mosquera D, Vidal JI, Ruiz E, Manjón L, Mauri M, Padró T, Miramontes JP, Mata P. Coronary Heart Disease, Peripheral Arterial Disease, and Stroke in Familial Hypercholesterolaemia. Arterioscler Thromb Vasc Biol 2016; 36:2004-10. [DOI: 10.1161/atvbaha.116.307514] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Objective—
Heterozygous familial hypercholesterolemia (FH) is the most common premature atherosclerotic cardiovascular disease (ASCVD)–related monogenic disorder, and it is associated with ischemic heart disease. There is limited information whether FH increases the risk of peripheral arterial and cerebrovascular disease. Our aim was to analyze ASCVD prevalence and characteristics in different arterial territories in a large FH population, to compare them with an unaffected control population and to determine which factors are associated to ASCVD.
Approach and Results—
SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) is an ongoing registry of molecularly defined patients with heterozygous FH in Spain. ASCVD in the different arterial territories was analyzed, as well as individual characteristics, genetic variables, and lipid-lowering therapies. The study recruited 4132 subjects (3745 ≥18 years); 2,752 of those enrolled were molecularly diagnosed FH cases. Median age was 44.0 years (45.9% men) and 40 years (46.6% men) in FH patients and unaffected relatives (
P
<0.001). ASCVD was present in 358 (13.0%) and 47 (4.7%) FH patients and unaffected relatives, respectively (
P
<0.001). History of premature ASCVD was more prevalent in FH patients (9.4% and 2.4% in FH patients and unaffected relatives, respectively;
P
<0.001). Coronary artery–related manifestations and peripheral artery disease were more prevalent in FH patients than in controls, but no significant differences were found for cerebrovascular events. Age, body mass index, type 2 diabetes mellitus, high blood pressure, previous use of tobacco, and lipoprotein(a) >50 mg/dL were independently associated with ASCVD.
Conclusions—
The prevalence of ASCVD is higher, and the involvement of the arterial territories is different in FH patients when compared with their unaffected relatives. Age, male sex, increased body mass index, hypertension, type 2 diabetes mellitus, smoking habit, and lipoprotein(a) >50 mg/dL were independently associated to ASCVD.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rodrigo Alonso
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Nelva Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Adriana Saltijeral
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Ovidio Muñiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Patricia Rubio-Marin
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José L. Diaz-Diaz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Francisco Fuentes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Raimundo de Andrés
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Zambón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Jesús Galiana
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Mar Piedecausa
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rocio Aguado
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Mosquera
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José I Vidal
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Enrique Ruiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Laura Manjón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Marta Mauri
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Teresa Padró
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José P. Miramontes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Pedro Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
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