Prevalence of Diabetes and Its Association with Atherosclerotic Cardiovascular Disease Risk in Patients with Familial Hypercholesterolemia: An Analysis from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH)

Chrysoula Boutari; Christos V Rizos; Michalis Doumas; George Liamis; Ioannis Skoumas; Loukianos Rallidis; Anastasia Garoufi; Genovefa Kolovou; Konstantinos Tziomalos; Emmanouil Skalidis; Vasileios Kotsis; George Sfikas; Vaia Lambadiari; Panagiotis Anagnostis; Eleni Bilianou; Georgia Anastasiou; Iosif Koutagiar; Estela Kiouri; Achilleas Attilakos; Vana Kolovou; Evangelos Zacharis; Christina Antza; Evangelos Liberopoulos

doi:10.3390/ph16010044

Prevalence of Diabetes and Its Association with Atherosclerotic Cardiovascular Disease Risk in Patients with Familial Hypercholesterolemia: An Analysis from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH)

Pharmaceuticals (Basel). 2022 Dec 28;16(1):44. doi: 10.3390/ph16010044.

Authors

Chrysoula Boutari¹, Christos V Rizos², Michalis Doumas¹, George Liamis², Ioannis Skoumas³, Loukianos Rallidis⁴, Anastasia Garoufi⁵, Genovefa Kolovou⁶, Konstantinos Tziomalos⁷, Emmanouil Skalidis⁸, Vasileios Kotsis⁹, George Sfikas¹⁰, Vaia Lambadiari¹¹, Panagiotis Anagnostis¹², Eleni Bilianou¹³, Georgia Anastasiou², Iosif Koutagiar³, Estela Kiouri⁴, Achilleas Attilakos¹⁴, Vana Kolovou⁶, Evangelos Zacharis⁸, Christina Antza⁹, Evangelos Liberopoulos¹⁵

Affiliations

¹ 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece.
² Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.
³ Cardiology Clinic, Hippokration General Hospital, 54643 Athens, Greece.
⁴ Department of Cardiology, Medical School, Attikon University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece.
⁵ 2nd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, 15452 Athens, Greece.
⁶ Cardiometabolic Center, Lipid Clinic, LA Apheresis Unit, Metropolitan Hospital, 15562 Athens, Greece.
⁷ 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece.
⁸ Cardiology Clinic, University General Hospital of Heraklion, 70013 Heraklion, Greece.
⁹ Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, 56429 Thessaloniki, Greece.
¹⁰ Department of Internal Medicine, 424 General Military Training Hospital, 56429 Thessaloniki, Greece.
¹¹ 2nd Propedeutic Internal Medicine Department and Diabetes Research Unit, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece.
¹² Department of Endocrinology, Police Medical Center, 54121 Thessaloniki, Greece.
¹³ Cardiology Clinic, "Tzaneio" General Hospital, 18536 Piraeus, Greece.
¹⁴ Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, C' Pediatrics Clinic, Attikon University General Hospital, 12462 Athens, Greece.
¹⁵ 1st Propedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527 Athens, Greece.

Abstract

Familial hypercholesterolemia (FH) and type 2 diabetes mellitus (T2DM) are both associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Little is known about the prevalence of T2DM and its association with ASCVD risk in FH patients. This was a cross-sectional analysis from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH) including adults with FH (n = 1719, mean age 51.3 ± 14.6 years). Of FH patients, 7.2% had a diagnosis of T2DM. The prevalence of ASCVD, coronary artery disease (CAD), and stroke was higher among subjects with T2DM compared with those without (55.3% vs. 23.3%, 48.8% vs. 20.7%, 8.3% vs. 2.7%, respectively, p < 0.001). When adjusted for age, systolic blood pressure, smoking, body mass index, hypertension, waist circumference, triglyceride levels, high-density lipoprotein cholesterol levels, and gender, T2DM was significantly associated with prevalent ASCVD [OR 2.0 (95% CI 1.2−3.3), p = 0.004]. FH patients with T2DM were more likely to have undergone coronary revascularization than those without (14.2% vs. 4.5% for coronary artery bypass graft, and 23.9% vs. 11.5% for percutaneous coronary intervention, p < 0.001). T2DM is associated with an increased risk for prevalent ASCVD in subjects with FH. This may have implications for risk stratification and treatment intensity in these patients.

Keywords: HELLAS-FH; cardiovascular disease; coronary artery disease; diabetes; familial hypercholesterolemia.

Grants and funding

This study is funded by the Hellenic Atherosclerosis Society (HAS), Greece from grants provided by Amgen, Sanofi, MSD, and Lilly. HAS covered the article processing charges.