Association between Primary Hypercholesterolemia, Including Familial Hypercholesterolemia, and Abdominal Aortic Aneurysm in the GeneralPopulation: Results of NDB-K7Ps-Study-5

Introduction: Patients with primary hypercholesterolemia (PH), including familial hypercholesterolemia (FH), are at elevated risk for cardiovascular disease. However, the associations between PH, FH, and aortic aneurysm, a life-threatening condition, remain unclear. This study aimed to investigate these associations in a general population using the Japanese National Database. Methods: We reviewed the data of 8,995,522 individuals aged 40–74 years who underwent annual health checkups. PH, including heterozygous/homozygous (definite FH) and non-classified FH (probable FH), chest aortic aneurysm (CAA), and abdominal aortic aneurysm (AAA), were determined based on medical insurance claim codes. Results: The prevalence of PH, including definite (n = 436) and probable FH (n = 2,857), was 0.18% (n = 16,338) in total. CAA and AAA accounted for 0.16% (n = 26) and 0.45% (n = 73) in PH patients, and 0.05% and 0.09% in non-PH patients, respectively. Among PH, non-FH, including familial-combined hyperlipidemia, and definite/probable FH were significantly associated with AAA even after adjusting for confounders, including pharmacotherapies for hypertension, diabetes, and dyslipidemia [ORs and 95% CIs, 1.96 (1.53-2.53) and 4.25 (2.33-7.44), both p < 0.001]. Discussion: This study explored significant associations between PH, FH, and aortic aneurysms, specifically AAA, all of them were rare in the general population, which was barely disclosed using the data of 9 million people who underwent regular checkup. Conclusion: PH and FH were associated with aortic aneurysms, particularly AAA, even in the research of the general population.