Assessment of coronary atherosclerosis in patients with familial hypercholesterolemia by coronary computed tomography angiography.

Abstract

The aims of this study were (1) to determine whether the accumulation of coronary plaque burden assessed with coronary computed tomography angiography (CCTA) can predict future events and (2) to estimate the onset and progression of coronary atherosclerosis in patients with familial hypercholesterolemia (FH). Consecutive 101 Japanese patients with heterozygous FH (men = 52, mean age 56 ± 16 years, mean low-density lipoprotein cholesterol 264 ± 58 mg/dl) who underwent 64-detector row CCTA without known coronary artery disease were retrospectively evaluated by assigning a score (0 to 5) to each of 17 coronary artery segments according to the Society of Cardiovascular Computed Tomography guidelines. Those scores were summed and subsequently natural log transformed. The periods to major adverse cardiac events (MACE) were estimated using multivariable Cox proportional hazards models. During the follow-up period (median 941 days), 21 MACE had occurred. Receiver operating characteristic curve analyses identified a plaque burden score of 3.35 (raw score 28.5) as the optimal cutoff for predicting a worse prognosis. Multivariate Cox regression analysis identified the presence of a plaque score ≥3.35 as a significant independent predictor of MACE (hazard ratio = 3.65; 95% confidence interval 1.32 to 25.84, p <0.05). The regression equations were Y = 0.68X - 15.6 (r = 0.54, p <0.05) in male and Y = 0.74X - 24.8 (r = 0.69, p <0.05) in female patients with heterozygous FH. In conclusion, coronary plaque burden identified in a noninvasive, quantitative manner was significantly associated with future coronary events in Japanese patients with heterozygous FH and that coronary atherosclerosis may start to develop, on average, at age 23 and 34 years in male and female patients with heterozygous FH, respectively.

• Authors: Hayato Tada, Masa-aki Kawashiri, Hirofumi Okada, Ryota Teramoto, Tetsuo Konno, Tsuyoshi Yoshimuta, Kenji Sakata, Atsushi Nohara, Akihiro Inazu, Junji Kobayashi, Hiroshi Mabuchi, Masakazu Yamagishi, Kenshi Hayashi
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 115 Issue 6 Pg. 724-9 (Mar 15 2015) ISSN: 1879-1913 [Electronic] United States
• PMID: 25618577 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Cholesterol, LDL

Topics

• Adult
• Aged
• Angioplasty, Balloon, Coronary (methods)
• Biomarkers (blood)
• Cholesterol, LDL (blood)
• Coronary Angiography (methods)
• Coronary Artery Disease (blood, diagnostic imaging, therapy)
• Female
• Follow-Up Studies
• Humans
• Hyperlipoproteinemia Type II (complications)
• Male
• Middle Aged
• Plaque, Atherosclerotic (diagnostic imaging)
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sensitivity and Specificity
• Severity of Illness Index
• Time Factors
• Tomography, X-Ray Computed (methods)