Lower risk of smoking-related cancer in individuals with familial hypercholesterolemia compared with controls: a prospective matched cohort study

Henriette W Krogh,Kirsten B Holven,Martin P Bogsrud,Trond P Leren,Jannicke Igland,Kjetil Retterstøl,Karianne Svendsen,Liv J Mundal

doi:10.1038/s41598-019-55682-x

Abstract

According to guidelines, individuals with familial hypercholesterolemia (FH) shall receive lifestyle intervention and intensive lipid-lowering treatment from early in life to reduce the risk of coronary heart disease. Our aim was to study if treatment of FH also could affect risk of lifestyle-related cancer. We presented cumulative incidence of total cancer and lifestyle-related cancer sites in individuals with genetically verified FH (n = 5531) compared with age and sex matched controls (n = 108354). Individuals with FH had 20% lower risk of smoking-related cancer compared with the control population [HR 0.80 (95% CI, 0.65–0.98)], in particular men with FH at 40–69 years at age of diagnosis with HR 0.69 (95% CI, 0.49–0.97). The FH population and controls had similar rates of total cancer [HR 0.97 (95% CI, 0.86–1.09)], cancer related to poor diet [HR 0.82 (95% CI, 0.59–1.15)], cancer related to physical inactivity [HR 0.93 (95% CI, 0.73–1.18)], alcohol-related cancer [HR 0.98 (95% CI, 0.80–1.22)] and cancer related to obesity [HR 1.03 (95% CI, 0.89–1.21)]. In summary, we found reduced risk of smoking-related cancer in individuals with FH, most likely due to a lower prevalence of smoking. Implications of these findings can be increased motivation and thus compliance to treatment of hypercholesterolemia.

Highlights

According to guidelines, individuals with familial hypercholesterolemia (FH) shall receive lifestyle intervention and intensive lipid-lowering treatment from early in life to reduce the risk of coronary heart disease
Familial hypercholesterolemia (FH) is a disorder usually caused by a mutation in the low density lipoprotein (LDL) receptor gene, causing elevated plasma levels of LDL cholesterol (LDL-C) which leads to increased risk of coronary heart disease (CHD)[2]
There were 14 incidence cases of cancer related to poor diet for women with FH and 434 for the female control population resulting in hazard ratios (HR) of 0.59

Summary

Introduction

Individuals with familial hypercholesterolemia (FH) shall receive lifestyle intervention and intensive lipid-lowering treatment from early in life to reduce the risk of coronary heart disease. We found reduced risk of smoking-related cancer in individuals with FH, most likely due to a lower prevalence of smoking Implications of these findings can be increased motivation and compliance to treatment of hypercholesterolemia. Cardiovascular disease (CVD) and cancer are the two main types of non-communicable diseases (NCDs) These diseases share several risk factors such as tobacco use, an unhealthy diet including low fruit and vegetable intake, lack of physical activity, and alcohol use[6]. We investigated whether treatment for FH results in lower risk of total and lifestyle-related cancer in people with FH compared with an age and sex matched control population

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