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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Early coronary calcifications are related to cholesterol burden in heterozygous familial hypercholesterolemia
Antonio Gallo1, Philippe Giral2, Alain Carrié3
1Unité de Prévention Cardiovasculaire, Service d'Endocrinologie-Métabolisme, Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'imagerie Biomédicale, Paris, France; Atherosclerosis Research Unit, Diabetes and Cardiovascular Prevention Unit, Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Insights
High cholesterol exposure in familial hypercholesterolemia patients is linked to early coronary artery calcification (CAC). CAC scoring can help identify those needing earlier, aggressive treatment for better cardiovascular outcomes.
Area of Science:
- Cardiology
- Genetics
- Radiology
Background:
- Identifying high-risk patients with heterozygous familial hypercholesterolemia (HeFH) for early intervention is challenging.
- Coronary Artery Calcification (CAC) score assesses coronary atherosclerotic burden and is validated for cardiovascular risk in the general population, but data in HeFH patients are limited.
Purpose of the Study:
- To evaluate the prevalence of CAC in HeFH patients.
- To investigate the relationship between CAC and lifelong cholesterol exposure, quantified by total cholesterol burden (TCB).
Main Methods:
- 112 HeFH patients were prospectively recruited.
- CAC score was determined using noncontrast multi-detector computed tomography.
- TCB was calculated using a formula incorporating total cholesterol levels and age at diagnosis and annually thereafter.
Main Results:
- A 58% prevalence of CAC was observed in the HeFH cohort.
- Patients with CAC had significantly higher TCB compared to those without (417.9 ± 89 vs. 298 ± 110 mmol-years/L, P < .001).
- Even in patients under 45 years old, 39% showed CAC, associated with higher TCB and initial total cholesterol levels.
Conclusions:
- Asymptomatic HeFH patients demonstrate early coronary atherosclerosis directly correlated with TCB.
- CAC scoring may serve as a valuable tool for identifying high-risk HeFH individuals who would benefit from earlier and more intensive treatment strategies.
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.
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