Assessments of Carotid Artery Plaque Burden in Patients With Familial Hypercholesterolemia
Hayato Tada1, Masa-Aki Kawashiri1, Hirofumi Okada1
1Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Insights
Carotid plaque score (cPS) better predicts coronary artery disease in familial hypercholesterolemia (FH) patients than carotid intima-media thickness (cIMT). cPS improves risk assessment, while cIMT does not. Carotid atherosclerosis develops earlier in males with FH.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Genetics
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol and premature cardiovascular disease.
- Carotid ultrasonography measures like carotid intima-media thickness (cIMT) and carotid plaque score (cPS) assess atherosclerosis severity.
- Direct comparison of cIMT and cPS clinical utility in FH patients is limited.
Purpose of the Study:
- To compare the clinical utility of cIMT and cPS in assessing coronary artery disease (CAD) risk in FH patients.
- To estimate the onset and progression of carotid atherosclerosis in FH patients.
Main Methods:
- Carotid ultrasonography was performed on 225 FH patients (126 males, mean age 51 ± 18 years).
- Baseline characteristics, lipid levels, traditional risk factors, and CAD presence were assessed.
- Multivariate logistic analysis and regression equations were used to evaluate cIMT and cPS associations with CAD and estimate atherosclerosis onset.
Main Results:
- cPS was significantly associated with CAD (OR 1.22, p=0.00036), while cIMT was not (OR 1.26, p=0.84).
- Adding cPS to traditional risk factors improved CAD risk discrimination (C-index 0.887 vs 0.909, p=0.030), but cIMT did not (C-index 0.887 vs 0.893, p=0.33).
- Regression models estimated carotid atherosclerosis onset at age 17 for males and 26 for females with heterozygous FH.
Conclusions:
- cPS offers superior risk stratification for CAD in FH patients compared to cIMT.
- cPS enhances the predictive value of traditional risk factors for CAD in FH.
- Carotid atherosclerosis may manifest earlier in life for individuals with FH, particularly males.
Abstract:
Although both carotid intima-media thickness (cIMT) and carotid plaque score (cPS) determined by carotid ultrasonography reflect the severity of coronary atherosclerosis, there are few reports on direct comparisons of their clinical utilities in patients with familial hypercholesterolemia (FH). We aimed (1) to compare the clinical utilities of these measurements and (2) to estimate the onset and progression of carotid atherosclerosis in patients with FH. We examined 225 patients with FH (126 males; mean age, 51 ± 18 years) who underwent carotid ultrasonography. We assessed baseline characteristics including lipid levels, other traditional risk factors, and the presence of coronary artery disease (CAD) as well as mean cIMT and cPS. Multivariate logistic analysis revealed that cPS was significantly associated with CAD (odds ratio [OR] 1.22, 95% confidence interval (CI) 1.10-1.37, p = 0.00036), whereas cIMT was not (OR 1.26, 95% CI 0.15 to 11.76, p = 0.84). Adding cPS information to other traditional risk factors improved the risk discrimination of CAD (C-index 0.887 vs 0.909, p = 0.030), whereas adding cIMT information did not (C-index 0.887 vs 0.893, p = 0.33). Regression equations were Y = 0.219X - 3.74 (r = 0.65, p < 0.001) in male and Y = 0.215X - 5.47 (r = 0.72, p < 0.001) in female patients with FH. In conclusion, cPS may provide superior risk stratification in patients with FH compared with cIMT. On average, carotid atherosclerosis may develop at 17 and 26 years of age in male and female patients with heterozygous FH, respectively.
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