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. 2025 Jul 21.
doi: 10.1038/s41371-025-01052-2. Online ahead of print.

Beyond lipid levels: unraveling the hypertensive factor in familial hypercholesterolemia. The HELLAS-FH registry

Christina Antza #  1 , Christos V Rizos #  2 , Vasileios Kotsis  1 , George Liamis  2 , Ioannis Skoumas  3 , Loukianos Rallidis  4 , Anastasia Garoufi  5 , George Sfikas  6 , Genovefa Kolovou  7 , Athanasios Penopoulos  8 , Emmanouil Skalidis  9 , Kimon Stamatelopoulos  10 , Michalis Doumas  11 , Vaia Lambadiari  12 , Panagiotis Anagnostis  13 , Evgenia Mavrokefalou  14 , Amalia Boufidou  15 , Vasiliki Giannakopoulou  16 , Georgia Anastasiou  2   17 , Ermioni Petkou  2 , Charalambos Vlachopoulos  3 , Ioanna Dima  3 , Georgios Fakas  4 , Konstantinos A Papathanasiou  4 , Achilleas Attilakos  18 , Charalambos Koumaras  6 , Vana Kolovou  7 , Dimitrios Agapakis  8 , Evangelos Zacharis  9 , Chrysoula Moustou  10 , Niki Katsiki  19   20 , Aikaterini Kountouri  12 , Eleni Mpellou  13 , Elisavet Prodromiadou  21 , Evangelos Liberopoulos  22
Affiliations

Beyond lipid levels: unraveling the hypertensive factor in familial hypercholesterolemia. The HELLAS-FH registry

Christina Antza et al. J Hum Hypertens. .

Abstract

Arterial hypertension (AH) and familial hypercholesterolemia (FH) are major risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which the coexistence of AH and FH amplifies the ASCVD risk is not well known. We aimed to explore the effect of AH on the prevalence of ASCVD in patients with FH. This was a cross-sectional analysis from the HELLAS-FH registry. A total of 2367 adults with heterozygous FH were studied. Out of these, 602 (25.4%) patients had AH. Patients with AH were more likely to have additional ASCVD risk factors (diabetes, smoking, obesity, elevated triglycerides and reduced high-density lipoprotein cholesterol levels) compared with patients without AH. Patients with AH had significantly higher prevalence of established coronary artery disease (CAD) (44 vs 14%, p < 0.001), premature CAD (39 vs 13%, p < 0.001), stroke (6 vs 2%, p < 0.001), and peripheral artery disease (6 vs 1%, p < 0.001) compared with those without after adjustment for major ASCVD risk factors. Systolic blood pressure (SBP) was significantly associated with increased odds of established CAD per 1 mmHg [odds ratio (OR) 1.075; 95% CI 1.001-1.153; p = 0.048], stroke (OR 1.023; 95% CI 1.004-1.042; p = 0.019) and PAD (OR 1.022; 95% CI 1.002-1.041; p = 0.028), while diastolic blood pressure showed no significant association with these outcomes. In conclusion, AH is associated with higher ASCVD risk factor burden and increased prevalence of ASCVD in patients with FH.

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Conflict of interest statement

Competing interests: CA, CVR, GL, AG, GS, PA, VK, GA, EP, ID, FG, KAP, AA, VK, CK, DA, CB, EM, AP have nothing to declare. IS has given talks, received honoraria, and participated in clinical trials sponsored by MSD, AMGEN, SANOFI. LR has received research grants and honoraria from Amgen, Sanofi-Aventis, Viatris, Novartis, Vianex and Servier. GK has given talks, attended conferences and participated in trials sponsored by Amgen, Angelini, MSD, Lilly, Vianex and Sanofi and has also accepted travel support to conferences from Amgen, Sanofi and MSD. ES has participated in educational and advisory activities sponsored by AstraZeneca, Medtronic, MSD, Sanofi and Servier. VK has given talks and attended conferences sponsored by AstraZeneca, MSD, Sanofi-Aventis, and Vianex. MD has given lectures for and participated in trials sponsored by Novo-Nordisc, Astra-Zeneca, Novartis, Eli-Lilly, Menarini, WinMedica, Innovis, Boehringer, Elpen, Viatris KS has received honoraria from Amgen. VL has given lectures, attended conferences and participated in trials sponsored by Novo Nordisk, Sanofi-Aventis, Novartis, AstraZeneca, Boehringer-Ingelheim, MSD, GSK, Vianex, Elli Lilly, ELPEN, Mylan and Aegereon. AB has received honoraria from Vianex, Amarin and Sanofi. EL has participated in educational, research and advisory activities sponsored by AstraZeneca, MSD, Lilly, Bayer, Amgen, Sanofi, Boehringer-Ingelheim, Novartis, Novo Nordisk, Valeant and Servier. EZ has received honoraria for lectures from Amgen. Sanofi, MSD, and Astra Zeneca. CV has received research grants and fees for scientific activities from Amgen, AstraZeneca, Boehringer-Ingelheim, ELPEN, Mylan, Novartis, Sanofi, MSD, and Vianex. HM participated in educational, research and consulting activities supported by healthcare companies, including Amgen, AstraZeneca, Boehringer Ingelheim, Elpen, Novartis, Sanofi, Vianex, Ultragenyx, Winmedica. ENL has participated in educational, research and advisory activities sponsored by AstraZeneca, MSD, Lilly, Bayer, Amgen, Sanofi, Boehringer Ingelheim, Novartis, Novo Nordisk, Valeant and Servier. Ethical approval: The study protocol was approved by all institutions’ scientific and ethics committees and the Hellenic Data Protection Authority. All methods were performed in accordance with the relevant guidelines and regulations. Written informed consent was obtained from all participants prior to inclusion in the registry.

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