Healthy lifestyle can cut CVD risk in patients with FH

A healthy lifestyle was associated with reduced risk for CVD among adults with familial hypercholesterolemia regardless of their familial hypercholesterolemia mutation status, researchers reported.

“DNA is not destiny; it is not deterministic for familial hypercholesterolemia (FH),” Hayato Tada, MD, PhD, assistant professor in the department of cardiovascular medicine at Kanazawa University Graduate School of Medical Sciences, Japan, told Healio. “Our study demonstrated that a healthy lifestyle was associated with reduced risk for CVD regardless of FH mutation status, suggesting that clinical and genetic diagnosis as FH is not deterministic for risk for CVD.”

‘Inherited risk can be mitigated’

Hayato Tada

In a retrospective study, Tada and colleagues analyzed data from 961 adults with diagnosed FH using 2017 Japan Atherosclerosis Society criteria between 1990 and 2000 at Kanazawa University Hospital. The mean age of patients was 52 years; 46.7% were men, 30.6% had a history of CVD and 699 were positive for an FH mutation. Researchers assessed the associations of the interaction between genotypes and lifestyle with the occurrence of major adverse CV events, including CV death, MI, unstable angina and coronary artery revascularization. Healthy lifestyle was defined as a healthy dietary pattern, regular exercise, not smoking and absence of obesity, all assessed via four questionnaires.

The findings were published in JACC: Asia.

During a median follow-up of 12.6 years, researchers observed 179 major adverse CV events.

Independent of classic risk factors, FH mutation was associated with risk for major adverse CV events, with an HR of 2.73 (95% CI, 1.03-4.43; P = .02), whereas high healthy lifestyle score was inversely associated (HR per 1 point = 0.69; 95% CI, 0.4-0.98; P = .033). The estimated risk for developing CAD by age 75 years varied according to lifestyle, ranging from 21% among noncarriers with a favorable lifestyle to 32.1% among noncarriers with an unfavorable lifestyle and ranging from 29% among carriers with a favorable lifestyle to 55.4% among carriers with an unfavorable lifestyle.

The researchers noted the data suggest clinical and genetic diagnosis of FH is not deterministic of risk for CVD.

“Rather, we are delighted to find that inherited risk can be mitigated by a healthy lifestyle,” the researchers wrote.

Tada told Healio that more research is needed to clarify when and which factors in particular should be considered as interventions for lifestyle in this high-risk group of patients.

Smoking cessation ‘strongest protective factor’

Raul D. Santos

In a related editorial, Raul D. Santos, MD, PhD, MSc, of the Heart Institute of University of Sao Paulo Medical School, noted that not smoking was the strongest protective factor against major adverse CV events, adding that the higher the healthy lifestyle score, the lower the risk, “clearly reinforcing the role of smoking cessation for prevention of atherosclerotic CVD in this high-risk population.”

“Moreover, physical activity and diet may be of extreme importance in modulating proatherogenic mechanisms and reducing ASCVD burden in FH,” Santos wrote.

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Hayato Tada, MD, PhD, can be reached at [email protected]; Twitter: @hayato_tada_ku.