Early coronary calcifications are related to cholesterol burden in heterozygous familial hypercholesterolemia.

Abstract

BACKGROUND:

The identification of high-risk patients with heterozygous familial hypercholesterolemia (HeFH) that may benefit from early treatment is challenging. Coronary Artery Calcification (CAC) score accounts for coronary atherosclerotic burden. It has proven its accuracy in cardiovascular risk assessment in the general population but data in HeFH are lacking.

OBJECTIVE:

The aim of our study was to assess CAC prevalence and its relationship with lifelong cholesterol exposure, calculated by total cholesterol burden (TCB) in patients with HeFH.

METHODS:

A total of 112 HeFH patients (50% males, median age 45 years) regularly followed-up since diagnosis were prospectively recruited at Pitié-Salpêtrière Hospital, Paris, France. CAC score was assessed using noncontrast multi-detector computed tomography. TCB was calculated as total cholesterol (TC) × age at diagnosis plus annually assessed TC.

RESULTS:

The prevalence of CAC was 58%. Patients without CAC showed lower TCB than patients with CAC (298 ± 110 vs 417.9 ± 89 mmol-years/L, P < .001). Among patients aged <45 years (n = 56), 39% exhibited CAC and a higher TCB compared with patients without CAC (352 ± 71 vs 255 ± 88 mmol-years/L, P < .001) due to higher TC levels at diagnosis (10.2 ± 2 vs 8.7 ± 2 mmol/L, P = .01). Multivariate analysis indicated that TCB was independently associated to CAC.

CONCLUSIONS:

Asymptomatic HeFH subjects exhibit early coronary atherosclerosis directly associated with TCB burden. CAC score may be useful to identify higher risk HeFH patients who can benefit from earlier and more aggressive treatment.

• Authors: Antonio Gallo, Philippe Giral, Alain Carrié, Valérie Carreau, Sophie Béliard, Randa Bittar, Marianna Maranghi, Marcello Arca, Philippe Cluzel, Alban Redheuil, Eric Bruckert, David Rosenbaum
• Journal: Journal of clinical lipidology (J Clin Lipidol) 2017 May - Jun Vol. 11 Issue 3 Pg. 704-711.e2 ISSN: 1933-2874 [Print] United States
• PMID: 28456681 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Chemical References

• Cholesterol

Topics

• Adult
• Calcinosis (complications)
• Cholesterol (metabolism)
• Coronary Artery Disease (complications)
• Female
• Heterozygote
• Humans
• Hyperlipoproteinemia Type II (complications, genetics, metabolism)
• Male
• Middle Aged
• Young Adult