HealthResJ, health, medicine, nursing, research

Prevalence of familial hypercholesterolemia in Attica region, Greece

Published: Feb 11, 2021
Familial hypercholesterolemia prevalence risk cardiovascular disease
Niki Pavlatou
Nikoletta Rovina
Georgia Toylia
Olga Kadda
Christina Marvaki
Theodore Kapadochos
Genovefa Kolovou
Antonia Koutsoukou

Background: Dyslipidemias are one of the major modifiable risk factors for cardiovascular disease. Familial hypercholesterolemia (FH) is the most common genetic metabolic disorder; it is estimated that around 14-34 million people worldwide have FH but only 25% of FH patients have been diagnosed. 

Aim: The aim of the present study was to explore the prevalence of FH in Attica region, Greece.

Methods: Attica region was divided into 8 regional units. A predesigned questionnaire was used to collect demographic and clinical data. Data analysis was performed by using the Statistical Package for the Social Sciences (SPSS), ver. 20.

Results: The studied sample consisted of 1578 Greek inhabitants of Attica region. The majority of the sample was women (59.9%). The mean age of the studied participants was 47.1 (±14.9) years. According to Simon Broome criteria, the probability of an FH diagnosis as unlikely is determined in 98.7% of the studied sample, probable in 0.8% of the participants or definite in 0.5% of the participants, based on this data, the prevalence of FH in Attica region, Greece is 1:200. Qualitative factors found to be associated with the onset of the disease were medication (p-value = 0.001) and hypolipidemic therapy (p-value = 0.001). The quantitative factors found to be associated with disease onset were body mass index (p-value = 0.044), and systolic (p-value = 0.001) and diastolic (p-value = 0.007) pressure.

Conclusions: Based on our data, the prevalence of FH in Attica region, Greece is 1:200. Early identification of contributing factors in FH development and proper treatment is vital and reduce the risk of premature and severe atherosclerotic disease.

Article Details
  • Section
  • Original Articles
Download data is not yet available.
Heidenreich P, Trogdon, J.G., Khavjou, O.A., Butler, J., Dracup, K., Ezekowitz, M.D., et al. Forecasting the future of cardiovascular disease in the U.SA: A policy statement from American Heart Association. Circulation. 2011;123:933-9442.
Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Med. 2013;11:117.
Zhu Y, Xian X, Wang Z, Bi Y, Chen Q, Han X, Tang D, Chen R. Research Progress on the Relationship between Athero-sclerosis and Inflammation. Biomolecules. 2018;8:80.
Ndrepepa G. Atherosclerosis & ischaemic heart disease: Here to stay or gone tomorrow.Indian J Med Res. 2017;146:293-297.
On line: Statistics Explained. Last ac-cessed: 28/11/2019.
Michas G, Karvelas G, Trikas A. Cardiovascular disease in Greece; the latest evidence on risk factors. Hellenic J Cardi-ol. 2019;60:271-275.
Vlachadis N, Iliodromiti Z, Vlachadi M, Xanthos T, Ktenas E, Vrachnis D, Kornarou E, Vrachnis N. Cardiovascular mortali-ty and the financial crisis in Greece: trends and outlook. Int J Cardiol. 2014;176:1367-8.
Pejic RN. Familial hypercholesterolemia.Ochsner J. 2014;14:669-72.
Ramasamy I.Update on the molecular biology of dyslipidemias.Clin Chim Acta. 2016;454:143-85.
Pitsavos C, Panagiotakos DB, Chrysohoou C, Stefanadis C. Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA study. BMC Public Health. 2003;3:32.
Kolovou G, Marvaki C, Makrygiannis S, Kadda O, Gianna-kopoulou V, Kalogeropoulos P, et al. Rationale and design of the Greek registry for familial hypercholesterolemia (GRegistry-FH) of the hellenic college of treatment of ath-erosclerosis (HCTA). Hellenic J Cardiol. 2019:S1109-9666(19)30281-7.
Rizos CV, Athyros V, Bilianou E, Chrousos G, Garoufi A, Ko-lovou G, et al. An insight into familial hypercholesterolemia in Greece: rationale and design of the Hellenic Familial Hy-percholesterolemia Registry (HELLAS-FH). Hormones (Ath-ens). 2017;16:306-312.
Al-Rasadi K, Al-Waili K, Al-Sabti HA, Al-Hinai A, Al-Hashmi K, Al-Zakwani I, et al.Criteria for Diagnosis of Familial Hy-percholesterolemia: A Comprehensive Analysis of the Dif-ferent Guidelines, Appraising their Suitability in the Omani Arab Population.Oman Med J. 2014;29:85-91.
Brunham LR, Ruel I, Khoury E, Hegele RA, Couture P, Ber-geron J, et al.Familial hypercholesterolemia in Canada: Ini-tial results from the FH Canada national regis-try.Atherosclerosis. 2018;277:419-424.
Béliard S, Boccara F, Cariou B, Carrié A, Collet X, Farnier M, et al; French FH Registry group.High burden of recurrent cardiovascular events in heterozygous familial hypercho-lesterolemia: The French Familial Hypercholesterolemia Registry.Atherosclerosis. 2018;277:334-340.
Kayikcioglu M, Tokgozoglu L, Dogan V, Ceyhan C, Tuncez A, Kutlu M, et al.What have we learned from Turkish famili-al hypercholesterolemia registries (A-HIT1 and A-HIT2)?Atherosclerosis. 2018;277:341-346.
Schmidt N, Dressel A, Grammer TB, Gouni-Berthold I, Julius U, Kassner U, et al.Lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients with familial hypercholesterolemia in Germany: The CaRe-High Registry.Atherosclerosis. 2018;277:314-322.
Amor-Salamanca A, Castillo S, Gonzalez-Vioque E, Dominguez F, Quintana L, Lluís-Ganella C, et al. J Am Coll Cardiol. 2017; 70(14):1732-1740.
Pirazzi C, Håkansson L, Gustafsson C, Omerovic E, Wiklund O, Mancina RM.High prevalence of genetic determined familial hypercholesterolemia in premature coronary artery disease.Appl Clin Genet. 2019;12:71-78.
Austin MA, Hutter CM, Zimmern RL, Humphries SE. Genetic causes of monogenic heterozygous familial hypercholes-terolemia: a HuGE prevalence review.Am J Epidemiol. 2004;160(5):407-20.
Wang Y, Li Y, Liu X, Tu R, Zhang H, Qian X, et al. The preva-lence and related factors of familial hypercholesterolemia in rural population of China using Chinese modified Dutch Lipid Clinic Network definition. BMC Public Health. 2019;19:837.
Thavendiranathan P, Jones E, Han RK, Cullen-Dean G, Hel-den E, Conner WT, et al. Association between physical ac-tivity, adiposity, and lipid abnormalities in children with familial hyperlipidemia. Eur J Cardiovasc Prev Rehabil. 2007;14:59-64.
Cui Y, Li S, Zhang F, Song J, Lee C, Wu M, Chen H. Preva-lence of familial hypercholesterolemia in patients with premature myocardial infarction. Clin Cardiol. 2019;42:385-390.
Besseling J, Kastelein JJ, Defesche JC, Hutten BA, Hovingh GK. Association between familial hypercholesterolemia and prevalence of type 2 diabetes mellitus. JAMA. 2015;313(10):1029-1036.
Rizos CV, Elisaf MS, Skoumas I, Tziomalos K, Kotsis V, Rallidis L, et al. Characteristics and management of 1093 patients with clinical diagnosis of familial hypercholester-olemia in Greece: Data from the Hellenic Familial Hyper-cholesterolemia Registry (HELLAS-FH).Atherosclerosis. 2018;277:308-313.
Dumitrescu A, Mosteoru S, Vinereanu D, Dan GA, Gaita L, Gaita D. Preliminary data of familial hypercholesterolemia (FH) patients in Romania. Atherosclerosis. 2018;277:304-307.
Benn M, Watts GF, Tybjærg-Hansen A, Nordestgaard BG. Mutations causative of familial hypercholesterolaemia: screening of 98 098 individuals from the Copenhagen General Population Study estimated a prevalence of 1 in 217.Eur Heart J. 2016;37:1384-94.
de Ferranti SD, Rodday AM, Mendelson MM, Wong JB, Leslie LK, Sheldrick RC. Prevalence of Familial Hypercholes-terolemia in the 1999 to 2012 United States National Health and Nutrition Examination Surveys (NHANES).Circulation. 2016;133:1067-72.
Most read articles by the same author(s)