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No correlation and low agreement of imaging and inflammatory atherosclerosis' markers in familial

Lilton R C Martinez1, Marcio H Miname, Luiz A Bortolotto

  • 1Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.

Atherosclerosis
|February 8, 2008
PubMed

Insights

Familial hypercholesterolemia (FH) patients show increased atherosclerosis and aortic stiffness. Clinical factors poorly predict these conditions, and imaging/inflammatory markers show low agreement for coronary heart disease risk prediction.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Research
  • Biomarkers

Background:

  • Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL-C levels and premature cardiovascular disease.
  • Subclinical atherosclerosis and aortic stiffness are early indicators of cardiovascular risk.
  • Inflammatory biomarkers may play a role in FH pathophysiology and disease progression.

Purpose of the Study:

  • To investigate determinants of subclinical atherosclerosis (coronary and carotid) and aortic stiffness in FH.
  • To examine the relationship between these vascular parameters and inflammatory biomarkers.
  • To assess the agreement of imaging and inflammatory markers for coronary heart disease (CHD) prediction in FH.

Main Methods:

  • Cross-sectional study comparing 89 FH patients with 31 normal subjects (NL).
  • Measurements included coronary calcium scores (CCS), carotid intima-media thickness (IMT), pulse wave velocity (PWV), C-reactive protein (CRP), and white blood cell count (WBC).
  • Multivariate analysis identified independent determinants for IMT, PWV, and coronary artery calcification (CAC). Agreement between markers was assessed using kappa statistics.

Main Results:

  • FH patients exhibited higher prevalence and severity of CAC, IMT, PWV, and WBC compared to NL (p<0.05).
  • Independent determinants identified: IMT (systolic blood pressure, Framingham Risk Score [FRS], apolipoprotein B), PWV (age), and CAC (male gender, LDL-cholesterol year score [LYS]).
  • Agreement between imaging and inflammatory markers for CHD prediction was poor (kappa<0.1), except for moderate agreement between IMT and PWV (kappa=0.5).

Conclusions:

  • Clinical parameters inadequately explain vascular variability (IMT, CAC, PWV) in FH subjects.
  • Imaging markers and inflammatory biomarkers demonstrate poor agreement in severity for predicting CHD risk in FH.
  • Further research is needed to refine risk stratification in FH patients.

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