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Carotid atherosclerosis in hypercholesterolemic patients: relationship with cardiovascular events
G Parrinello1, C M Barbagallo, A Pinto
1Chair of Internal Medicine, Institute of Medical Clinic, University of Palermo, Palermo, Italy.
Insights
Hypercholesterolemia patients with carotid lesions face a higher risk of cardiovascular events. Ultrasound screening of carotid arteries is recommended for early detection and management in these high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Lipid Metabolism
Background:
- Extracranial cerebrovascular atherosclerosis is common in hypercholesterolemia.
- Carotid lesions are established predictors of cardiovascular events.
- Understanding factors associated with carotid damage in hypercholesterolemic patients is crucial.
Purpose of the Study:
- To investigate factors associated with carotid artery damage in hypercholesterolemic patients.
- To determine the relationship between carotid lesions and clinical cardiovascular events.
- To assess the predictive value of carotid status in hypercholesterolemia.
Main Methods:
- 117 hypercholesterolemic subjects without prior cardiovascular events were examined.
- Lipoprotein levels were determined, and high-resolution B-mode ultrasound of carotid arteries was performed.
- Subjects were followed for 4 years, recording major cardiovascular events.
Main Results:
- Prevalence of increased intima-media thickness (21.4%) and plaque (29.9%) was higher than in normolipidemic controls.
- Carotid lesions correlated significantly with age, hypertension, LDL-cholesterol, and HDL-cholesterol.
- Major clinical events were independently associated with familial hypercholesterolemia, carotid score, and LDL/HDL levels.
Conclusions:
- Common risk factors and lipoprotein levels synergistically increase carotid lesion frequency in hypercholesterolemia.
- Carotid lesions are significant predictors of clinical events in this population.
- Routine B-mode ultrasound of carotids is recommended for managing hypercholesterolemic patients.
Background And Aim:
Extracranial cerebrovascular atherosclerosis is a common feature of hypercholesterolemia and carotid lesions are good predictors of cardiovascular events in the general population. Factors associated with the carotid damage of hypercholesterolemic patients and their relationships with the occurrence of clinical events are investigated in this study.
Methods And Results:
One hundred and seventeen cardiovascular event-free hypercholesterolemic subjects underwent a complete clinical examination to look for additional risk factors. A blood sample was collected for lipoprotein determination and an ultrasound high resolution B-mode imaging examination of the common carotid arteries was performed. Patients were treated according to the current guidelines during a 4-yr follow-up and all major cardiovascular events were recorded. The prevalence of subjects with increased intima-media thickness and plaque was 21.4% and 29.9% respectively, higher than in normolipidemic controls. Carotid lesions were significantly related to age, hypertension and LDL-cholesterol and HDL-cholesterol levels. The relative risk of developing a major clinical event was 3.92 (95% CI 1.54-9.95, p < 0.004) among categories of carotid status. At multivariate analysis, cardiovascular events were independently related to the diagnosis of familial hypercolesterolemia (FH), baseline carotid score and mean levels of LDL-cholesterol and HDL-cholesterol during the follow-up.
Conclusions:
Common risk factors cooperate with plasma lipoprotein levels in increasing the frequency of carotid lesions of hypercholesterolemic patients. Since such lesions are useful predictors of clinical events, B-mode ultrasound evaluation of the carotids should be routinely included in the management of these patients.