Mental Health and Physical Activity May Be Associated in Homozygous Familial Hypercholesterolemia

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Mental health disturbances were found to be common in patients with homozygous familial hypercholesterolemia.

Mental health disturbances were found to be common in patients with homozygous familial hypercholesterolemia (HoFH), and the mental health status of these patients was found to be associated with lifestyle behaviors, according to a study published in the Journal of Clinical Lipidology.

Patients with HoFH are at increased risk for premature morbidity and mortality due to very high levels of low-density lipoprotein (LDL) cholesterol since birth. With a subgroup analysis of the nationwide A-HIT1 registry in Turkey, investigators aimed to assess whether the mental status of adult patients with HoFH was associated with lifestyle behaviors.

Patients completed the Symptom Checklist-90-Revised (SCL-90-R) screening tool to assess psychopathology. In the SCL-90-R tool, 9 categories of mental health symptoms are assessed: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The global severity index is the average score of all items on the SCL-90-R tool.

A total of 68 patients (45.6% women) with a clinical diagnosis of HoFH undergoing therapeutic LDL apheresis were included in the analysis. Obsessive compulsive behavior (35.8%) was the main pathology reported in the SCL-90-R tool in this cohort, followed by somatization and interpersonal sensitivity (33.8% each), and depression (32.4%).

Cardiovascular involvement, which was present in 44 patients, was found to be associated with anxiety (odds ratio [OR], 5.028, 95% CI, 1.20-21.11; P =.027), depression (OR, 3.013; 95% CI, 1.11-8.21; P =.031), obsessive compulsive (OR, 2.853; 95% CI, 1.08-7.54; P =.034), somatization (OR, 3.102; 95% CI, 1.05-9.19; P =.041), and global severity index (OR, 4.153; 95% CI, 1.08-15.98; P =.038).

Lower age at first coronary event was significantly associated with better psychiatric status and global severity index (correlation coefficient, 0.392; P =.018).

A total of 53% of patients in this cohort did not exercise regularly. Physical inactivity was associated with a higher global severity index (OR, 4.499; 95% CI, 1.417-14.287; P =.011), as well as obsessive compulsive (OR, 2.854; 95% CI, 1.239-6.573; P =.014), interpersonal sensitivity (OR, 3.132; 95% CI, 1.55-7.817; P -.014), paranoid ideation (OR, 2.910; 95% CI, 1.219-6.947; P =.016), hostility (OR, 2.777; 95% CI, 1.174-6.571; P =.020), and anxiety (OR, 3.898; 95% CI, 1.244-12.215; P =.020).

Study limitations include its cross-sectional nature that prevents the detection of causal relationships between exercise and mental health, and the fact that higher SCL-90-R scores may be related to LDL apheresis.

“In the HoFH population, there was a high prevalence of mental disturbances. Better psychiatric status was associated with regular exercising,” the study authors concluded. “Therefore, assessing the mental status of patients [with HoFH] and referring patients in need, to a psychiatrist may improve the outcome of patients.”

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Disclosures: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Tunçel ÖK, Kayıkçıoğlu M, Pırıldar Ş, et al. Mental status and physical activity in patients with homozygous familial hypercholesterolemia: A subgroup analysis of a nation-wide survey (A-HIT1 registry) [published online April 20, 2020]. Journal of Clinical Lipidology. doi:10.1016/j.jacl.2020.04.006