Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a representative population sample of the Czech Republic and to analyze the longitudinal trends in the basic characteristics of individuals with severe dyslipidemia. Methods: Seven independent cross-sectional surveys were organized in the Czech Republic to screen for major cardiovascular risk factors (from 1985 to 2015-2018). A total of 20,443 randomly selected individuals aged 25-64 years were examined. Results: The overall prevalence of severe dyslipidemia was 6.6%, with a significant downward trend from the fifth survey onwards (2000/2001). Over the study period of 30+ years, the individuals with severe dyslipidemia became older, increased in BMI, and did not change their smoking habits. Total cholesterol and non-HDL-cholesterol decreased significantly in both sexes throughout the duration of the study. Conclusions: Despite a significant improvement in lipids in the Czech Republic from 1985, substantially contributing to the decline in cardiovascular mortality, the number of individuals with severe dyslipidemia remained high, and in most cases, they were newly detected during our screening examinations and were thus untreated.

Atherosclerosis Research Laboratory Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Center for Cardiovascular Prevention Charles University Prague 1st Faculty of Medicine and Thomayer University Hospital 140 59 Prague Czech Republic

Department of Medicine 2 Charles University Prague 1st Faculty of Medicine 128 08 Prague Czech Republic

Department of Medicine 2 Faculty of Medicine Charles University 301 00 Pilsen Czech Republic

Department of Medicine 3 Charles University Prague 1st Faculty of Medicine 128 08 Prague Czech Republic

Department of Therapy №1 Medical Diagnostics Hematology and Transfusiology Lviv Danylo Halytsky National Medical University 79010 Lviv Ukraine

Medical Statistics Unit Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Zobrazit více v PubMed

Timmis A., Vardas P., Townsend N., Torbica A., Katus H., De Smedt D., Gale C.P., Maggioni A.P., Petersen S.E., Huculeci R., et al. European Society of Cardiology: Cardiovascular disease statistics 2021. Eur. Heart J. 2022;43:716–799. doi: 10.1093/eurheartj/ehab892. PubMed DOI

Cífková R., Skodová Z., Bruthans J., Holub J., Adámková V., Jozífová M., Galovcová M., Wohlfahrt P., Krajčoviechová A., Petržílková Z., et al. Longitudinal trends in cardiovascular mortality and blood pressure levels, prevalence, awareness, treatment, and control of hypertension in the Czech population from 1985 to 2007/2008. J. Hypertens. 2010;28:2196–2203. doi: 10.1097/HJH.0b013e32833d4451. PubMed DOI

Visseren F.L.J., Mach F., Smulders Y.M., Carballo D., Koskinas K.C., Bäck M., Benetos A., Biffi A., Boavida J.M., Capodanno D., et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 2021;42:3227–3337. doi: 10.1093/eurheartj/ehab484. PubMed DOI

Mach F., Baigent C., Catapano A.L., Koskinas K.C., Casula M., Badimon L., Chapman M.J., De Backer G.G., Delgado V., Ference B.A., et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur. Heart J. 2020;41:111–188. doi: 10.1093/eurheartj/ehz455. PubMed DOI

Bruthans J., Cífková R., Lánská V., O’Flaherty M., Critchley J.A., Holub J., Janský P., Zvárová J., Capewell S. Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007. Eur. J. Prev. Cardiol. 2014;21:829–839. doi: 10.1177/2047487312469476. PubMed DOI

Cífková R., Bruthans J., Wohlfahrt P., Krajčoviechová A., Šulc P., Jozífová M., Eremiášová L., Pudil J., Linhart A., Widimský J., Jr., et al. 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post-MONICA, 1985–2016/17. PLoS ONE. 2020;15:e0232845. doi: 10.1371/journal.pone.0232845. PubMed DOI PMC

Perak A.M., Ning H., de Ferranti S.D., Gooding H.C., Wilkins J.T., Lloyd-Jones D.M. Long-Term Risk of Atherosclerotic Cardiovascular Disease in US Adults With the Familial Hypercholesterolemia Phenotype. Circulation. 2016;134:9–19. doi: 10.1161/CIRCULATIONAHA.116.022335. PubMed DOI PMC

Tunstall-Pedoe H., Kuulasmaa K., Mähönen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999;353:1547–1557. doi: 10.1016/S0140-6736(99)04021-0. PubMed DOI

Cífková R., Skodová Z., Bruthans J., Adámková V., Jozífová M., Galovcová M., Wohlfahrt P., Krajcoviechová A., Poledne R., Stávek P., et al. Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/8. Czech MONICA and Czech post-MONICA. Atherosclerosis. 2010;211:676–681. doi: 10.1016/j.atherosclerosis.2010.04.007. PubMed DOI

Friedewald W.T., Levy R.I., Fredrickson D.S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem. 1972;18:499–502. doi: 10.1093/clinchem/18.6.499. PubMed DOI

Evans A., Tolonen H., Hense H.W., Ferrario M., Sans S., Kuulasmaa K. Trends in coronary risk factors in the WHO MONICA project. Int. J. Epidemiol. 2001;30((Suppl. S1)):S35–S40. doi: 10.1093/ije/30.suppl_1.S35. PubMed DOI

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183–1197. doi: 10.2337/diacare.20.7.1183. PubMed DOI

Sniderman A.D., Tsimikas S., Fazio S. The severe hypercholesterolemia phenotype: Clinical diagnosis, management, and emerging therapies. J. Am. Coll. Cardiol. 2014;63:1935–1947. doi: 10.1016/j.jacc.2014.01.060. PubMed DOI

Bucholz E.M., Rodday A.M., Kolor K., Khoury M.J., de Ferranti S.D. Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014) Circulation. 2018;137:2218–2230. doi: 10.1161/CIRCULATIONAHA.117.032321. PubMed DOI PMC

Saadatagah S., Alhalabi L., Farwati M., Zordok M., Bhat A., Smith C.Y., Wood-Wentz C.M., Bailey K.R., Kullo I.J. The burden of severe hypercholesterolemia and familial hypercholesterolemia in a population-based setting in the US. Am. J. Prev. Cardiol. 2022;12:100393. doi: 10.1016/j.ajpc.2022.100393. PubMed DOI PMC

Kutkienė S., Petrulionienė Ž., Laucevičius A., Petrylaitė M., Maskeliūnaitė D., Puronaitė R., Kovaitė M., Kalibaitaitė I., Rinkūnienė E., Dženkevičiūtė V., et al. Severe dyslipidemia and concomitant risk factors in the middle-aged Lithuanian adults: A cross-sectional cohort study. Lipids Health Dis. 2018;17:88. doi: 10.1186/s12944-018-0731-7. PubMed DOI PMC

Jansen A.C., van Aalst-Cohen E.S., Tanck M.W., Trip M.D., Lansberg P.J., Liem A.H., van Lennep H.W., Sijbrands E.J., Kastelein J.J. The contribution of classical risk factors to cardiovascular disease in familial hypercholesterolaemia: Data in 2400 patients. J. Intern. Med. 2004;256:482–490. doi: 10.1111/j.1365-2796.2004.01405.x. PubMed DOI

Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., Clement D.L., Coca A., de Simone G., Dominiczak A., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 2018;36:1953–2041. PubMed

Tolonen H., Dobson A., Kulathinal S. Assessing the quality of risk factor survey data: Lessons from the WHO MONICA Project. Eur. J. Cardiovasc. Prev. Rehabil. 2006;13:104–114. PubMed

Ahmad Z., Adams-Huet B., Chen C., Garg A. Low prevalence of mutations in known loci for autosomal dominant hypercholesterolemia in a multiethnic patient cohort. Circ. Cardiovasc. Genet. 2012;5:666–675. doi: 10.1161/CIRCGENETICS.112.963587. PubMed DOI PMC

Khera A.V., Won H.H., Peloso G.M., Lawson K.S., Bartz T.M., Deng X., van Leeuwen E.M., Natarajan P., Emdin C.A., Bick A.G., et al. Diagnostic Yield and Clinical Utility of Sequencing Familial Hypercholesterolemia Genes in Patients With Severe Hypercholesterolemia. J. Am. Coll. Cardiol. 2016;67:2578–2589. doi: 10.1016/j.jacc.2016.03.520. PubMed DOI PMC

Ruel I., Brisson D., Aljenedil S., Awan Z., Baass A., Bélanger A., Bergeron J., Bewick D., Brophy J.M., Brunham L.R., et al. Simplified Canadian Definition for Familial Hypercholesterolemia. Can. J. Cardiol. 2018;34:1210–1214. doi: 10.1016/j.cjca.2018.05.015. PubMed DOI

Cholesterol associated genetic risk score and acute coronary syndrome in Czech males