Impact of Healthy Lifestyle in Patients With Familial Hypercholesterolemia

Hayato Tada; Nobuko Kojima; Kan Yamagami; Akihiro Nomura; Atsushi Nohara; Soichiro Usui; Kenji Sakata; Kenshi Hayashi; Noboru Fujino; Masayuki Takamura; Masa-Aki Kawashiri

doi:10.1016/j.jacasi.2022.10.012

Impact of Healthy Lifestyle in Patients With Familial Hypercholesterolemia

JACC Asia. 2023 Jan 31;3(1):152-160. doi: 10.1016/j.jacasi.2022.10.012. eCollection 2023 Feb.

Affiliations

¹ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
² Department of Clinical Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
³ Department of Internal Medicine, Kaga Medical Center, Kaga, Japan.

Abstract

Background: Pathogenic mutations are associated with poor outcomes in patients with familial hypercholesterolemia (FH). However, data on the effects of a healthy lifestyle on FH phenotypes are limited.

Objectives: The authors investigated the interaction between a healthy lifestyle and FH mutation with prognosis in patients with FH.

Methods: We investigated the associations of the interaction between genotypes and lifestyle, with the occurrence of major adverse cardiac events (MACE), such as cardiovascular-related mortality, myocardial infarction, unstable angina, and coronary artery revascularization, in patients with FH. We assessed their lifestyle based on 4 questionnaires (healthy dietary pattern, regular exercise, not smoking, and absence of obesity). The Cox proportional hazards model was used to assess the risk for MACE.

Results: The median follow-up duration was 12.6 (IQR: 9.5-17.9) years. During the follow-up duration, 179 MACE were observed. Independent of classic risk factors, FH mutation and lifestyle score were significantly associated with MACE (HR: 2.73; 95% CI: 1.03-4.43; P = 0.02; and HR: 0.69, 95% CI: 0.40-0.98, P = 0.033, respectively). The estimated risk of coronary artery disease by 75 years of age varied according to lifestyle, ranging from 21.0% among noncarriers with a favorable lifestyle to 32.1% among noncarriers with an unfavorable lifestyle and ranging from 29.0% among carriers with a favorable lifestyle to 55.4% among carriers with an unfavorable lifestyle.

Conclusions: A healthy lifestyle was associated with reduced risk for MACE among patients with FH with or without genetic diagnosis.

Keywords: CVD, cardiovascular disease; FH, familial hypercholesterolemia; LDL cholesterol; LDL receptor; LDL, low-density lipoprotein; MACE, major adverse cardiac event(s); familial hypercholesterolemia; genetics; lifestyle.