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Familial hypercholesterolemia prevalence in an admixed racial society: Sex and race matter. The ELSA-Brasil

  • Paulo H. Harada
    Affiliations
    Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, 2565 Prof. Lineu Prestes Avenue, Sao Paulo, 05508-000, Brazil
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  • Marcio H. Miname
    Affiliations
    Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
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  • Isabela M. Benseñor
    Affiliations
    Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, 2565 Prof. Lineu Prestes Avenue, Sao Paulo, 05508-000, Brazil
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  • Raul D. Santos
    Affiliations
    Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil

    Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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  • Paulo A. Lotufo
    Correspondence
    Corresponding author. Center for Clinical and Epidemiologic Research University Hospital at University of Sao Paulo, Av Lineu Prestes, 2565, Sao Paulo, 05508-000, Brazil.
    Affiliations
    Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, 2565 Prof. Lineu Prestes Avenue, Sao Paulo, 05508-000, Brazil
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      Highlights

      • Overall Familial hypercholesterolemia (FH) prevalence in ELSA-Brasil is 1 in 263.
      • From White to Brown to Black Race/Ethnicity, there is increasing FH prevalence.
      • Weighted extrapolation for the Brazilian population derived similar frequencies.

      Abstract

      Background and aims

      Familial hypercholesterolemia (FH) is a genetic disorder associated with high cardiovascular burden of disease. FH prevalence may vary widely across populations and data in race/ethnically diverse and admixed populations is scarce. ELSA-Brasil epidemiology may be widely generalizable in this regard, and we calculated the ELSA-Brasil FH prevalence and its variation according to age, sex and race/ethnicity.

      Methods

      In 14,460 individuals aged from 35 to 75 years from the ELSA-Brasil cohort baseline, we classified FH according to the Dutch Lipid Clinic Network criteria score ≥6 (probable and definite FH). LDL-C levels were adjusted for statin use. We calculated the overall ELSA-Brasil FH prevalence and the weighted prevalence for age, sex and race/ethnic categories. We extrapolated those frequencies to the Brazilian population weighting for age-sex-race/ethnicity according to the 2015 Statistics and Geography Brazilian Institute survey.

      Results

      The overall FH prevalence per 1000 individuals in ELSA-Brasil was 3.8 (2.9, 4.9) or 1 in 263. The age/sex/race-ethnicity-weighted FH prevalences were: male, 3.0 (1.7, 4.4) or 1 in 333; female, 4.1 (3.0, 5.2) or 1 in 244 (p<0.001). White race prevalence was 2.4 (1.9, 3.0) or 1 in 417; Brown, 4.9 (4.0, 5.9) or 1 in 204; and Black 6.4 (41.1, 8.7) or 1 in 156 (p<0.001). The weighted extrapolation for the Brazilian population derived similar magnitude frequencies.

      Conclusions

      FH affects 1 in 263 in ELSA-Brasil and affects disproportionally more Brown (1 in 204), and Black (1 in 156), than White (1 in 417). Weighted extrapolation for the Brazilian population derived similar magnitude frequencies.

      Keywords

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