Increased risk of heart failure and atrial fibrillation in heterozygous familial hypercholesterolemia

Anders Hovland; Liv J Mundal; Jannicke Igland; Marit B Veierød; Kirsten B Holven; Martin P Bogsrud; Grethe S Tell; Trond P Leren; Kjetil Retterstøl

doi:10.1016/j.atherosclerosis.2017.09.027

Increased risk of heart failure and atrial fibrillation in heterozygous familial hypercholesterolemia

Atherosclerosis. 2017 Nov:266:69-73. doi: 10.1016/j.atherosclerosis.2017.09.027. Epub 2017 Sep 28.

Authors

Anders Hovland¹, Liv J Mundal², Jannicke Igland³, Marit B Veierød⁴, Kirsten B Holven⁵, Martin P Bogsrud⁶, Grethe S Tell⁷, Trond P Leren⁸, Kjetil Retterstøl⁹

Affiliations

¹ Division of Internal Medicine, Nordland Hospital, Bodø, Norway; Department of Clinical Medicine, University of Tromsø, Tromsø, Norway. Electronic address: anders.w.hovland@gmail.com.
² The Lipid Clinic, Oslo University Hospital Rikshospitalet, Oslo, Norway.
³ Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁴ Department of Nutrition, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway.
⁵ Department of Nutrition, University of Oslo, Oslo, Norway; National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.
⁶ National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway.
⁷ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.
⁸ Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital Ullevål, Oslo, Norway.
⁹ The Lipid Clinic, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Nutrition, University of Oslo, Oslo, Norway.

PMID: 28992466
DOI: 10.1016/j.atherosclerosis.2017.09.027

Abstract

Background and aims: Heart failure (HF) and atrial fibrillation/flutter (AF) are important causes of morbidity and mortality. Subjects with familial hypercholesterolemia (FH) carry a high risk of coronary artery disease (CAD) but it is not known if the risk of HF and AF is increased in FH. The present study investigated the incidence of hospitalization for HF and AF in a genetically verified FH cohort, age 25 years and older, compared to the general population.

Methods: Incidence rates of hospitalization for HF and AF were estimated from national registry data. Standardized incidence ratios (SIRs) were calculated.

Results: 4273 genotyped FH patients (51.7% women) with a total observation period of 18,300 patient years were studied. Overall, the expected number of FH patients with HF was 27.7 and the observed number of cases was 54 (SIR (95% CI) 2.0 (1.5-2.6)). The highest excess risk was observed in the age group 25-49 years, where SIRs were 3.8 (1.2-11.8) and 4.2 (2.0-8.8) in women and men, respectively. The total expected number of FH patients with AF was 39.4 while the observed number of cases was 77 (SIR 2.0 (1.6-2.4)). Among FH patients with an incident event of HF, nearly 90% had a previous diagnosis of CAD, and nearly 40% had suffered from a myocardial infarction.

Conclusions: We demonstrate a doubling of the risk of hospitalization for HF or AF in patients with FH. This is could have an important prognostic impact for patients and economic impact for the society.

Keywords: Atrial fibrillation; Familial hypercholesterolemia; Heart failure.

MeSH terms

Adult
Age Distribution
Aged
Atrial Fibrillation / diagnosis
Atrial Fibrillation / epidemiology*
Atrial Fibrillation / therapy
Female
Genetic Predisposition to Disease
Heart Failure / diagnosis
Heart Failure / epidemiology*
Heart Failure / therapy
Heterozygote
Hospitalization
Humans
Hyperlipoproteinemia Type II / diagnosis
Hyperlipoproteinemia Type II / epidemiology*
Hyperlipoproteinemia Type II / genetics
Incidence
Male
Middle Aged
Norway / epidemiology
Phenotype
Prognosis
Prospective Studies
Registries
Risk Assessment
Risk Factors
Time Factors