Anxiety, depression, and health-related quality of life in heterozygous familial hypercholesterolemia: A systematic review and meta-analysis

• Published in: Journal of psychosomatic research 2018-06, Vol.109, p.32-43
• Main Authors: Akioyamen, Leo E., Genest, Jacques, Shan, Shubham D., Inibhunu, Happy, Chu, Anna, Tu, Jack V.
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Cardiovascular diseases; Confidence intervals; Data processing; Depression; Familial hypercholesterolemia; Family medical history; Health status; Health-related quality of life; High risk; Hypercholesterolemia; Mental depression; Meta-analysis; Psychosocial factors; Psychosocial well being; Quality of life; Symptoms; Systematic review; Uncertainty
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2018.03.170

Heterozygous familial hypercholesterolemia (FH) is a common genetic disease predisposing affected individuals to a high risk of cardiovascular disease. Yet, considerable uncertainty exists regarding its impact on psychosocial wellbeing. We performed a systematic review and meta-analysis of the association between FH and symptoms of anxiety and depression, and health-related quality of life (HRQL). We searched MEDLINE, EMBASE, Global Health, the Cochrane Library, PsycINFO, and PubMed for peer-reviewed literature published in English between January 1, 1990 and January 1, 2018. Quantitative and qualitative studies were eligible if they included patients with confirmed FH and evaluated its association with symptoms of anxiety or depression, or HRQL. We performed a narrative synthesis of studies, including thematic analysis of qualitative studies, and where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals. We found 10 eligible studies measuring HRQL, depression and anxiety. Random-effects meta-analysis of 4 (n = 4293) and 5 studies (n = 5098), respectively, showed that patients with FH had slightly lower symptoms of anxiety (SMD: −0.29 [95% CI: −0.53, −0.04]) and mental HRQL (SMD: −0.10 [95% −0.20, −0.00]) relative to general population controls. No significant differences existed in depressive symptoms (SMD: 0.04 [95% CI: −0.12, 0.19]) or physical HRQL scores (SMD: 0.02 [95% CI: −0.09, 0.12]). Our systematic review suggests that patients with FH may report small but measurable differences in anxiety symptoms and mental HRQL. •Participants with FH had lower mean anxiety scores and better mental health related quality of life (HRQL) relative to the general population.•There was no difference between FH and the general population in depression or physical HRQL.•Male sex, younger age, higher educational levels, and lipid-lowering therapy treatment were associated with better HRQL.•Patients who were older, less educated, not living with a partner, and had at least one comorbidity had the poorest HRQL.