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Coronary computed tomographic angiography findings and their therapeutic implications in asymptomatic patients with
Leopoldo Pérez de Isla1, Rodrigo Alonso2, Ovidio Muñiz-Grijalvo3
1Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
Insights
Familial hypercholesterolemia (FH) significantly increases risk for early heart disease. Coronary CTA reveals prevalent atherosclerosis in asymptomatic FH patients, impacting care and risk assessment.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Genetics
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to elevated LDL cholesterol and increased risk of premature atherosclerotic cardiovascular disease.
- Coronary computed tomographic angiography (CTA) is a non-invasive imaging technique capable of detecting and quantifying preclinical coronary atherosclerosis.
Purpose of the Study:
- To characterize coronary CTA findings in asymptomatic individuals with molecularly confirmed FH.
- To identify factors associated with the presence and extent of coronary atherosclerosis in this population.
- To evaluate the impact of CTA findings on patient management and cardiovascular risk estimation.
Main Methods:
- A cohort of 440 asymptomatic FH patients without established cardiovascular disease underwent coronary CTA.
- Coronary atherosclerosis was assessed using coronary calcium score (CCS), stenosis severity, and plaque composition score (PCS).
- Cardiovascular risk was calculated using the SAFEHEART equation, and patients were followed prospectively.
Main Results:
- Coronary calcium was detected in 55% of patients (mean CCS 130.9).
- Significant plaque burden (mean PCS 1.1) and lumen involvement (46%) were observed.
- CCS, stenosis severity, and PCS were independently associated with estimated cardiovascular risk and LDL-cholesterol exposure.
- CTA findings led to positive changes in patient care and risk stratification.
Conclusions:
- Coronary artery atherosclerosis is highly prevalent in asymptomatic FH patients and correlates with cardiovascular risk.
- Advanced coronary atherosclerosis detected by CTA influenced treatment intensification and risk reduction strategies.
- Further research is needed to confirm the utility of CTA in improving risk stratification for FH patients.
Background:
Familial hypercholesterolemia (FH) confers an increased risk of premature atherosclerotic disease. Coronary computed tomographic angiography (CTA) can assess preclinical coronary atherosclerosis.
Objectives:
To describe coronary CTA findings in asymptomatic molecularly defined FH individuals, to identify those factors related to its presence and extension, and to assess the impact of these results in patients' care and estimated risk.
Methods:
Four hundred and forty individuals with FH, without clinical cardiovascular disease, were consecutively enrolled and underwent a coronary CTA that was used to analyze coronary atherosclerosis based on coronary calcium score (CCS), sum of stenosis severity, and plaque composition sum (PCS). For FH patients, cardiovascular risk was estimated using the specific SAFEHEART risk equation. Follow-up was performed using a standardized protocol.
Results:
Mean age was 46.4 years (231 women, 52%). Coronary calcium was present in 55%, mean CCS was 130.9, 46% had a plaque with lumen involvement, and mean PCS was 1.1. During follow-up, there were 17 (4%) nonfatal events and 2 (1%) fatal events. CCS was independently associated to the estimated risk and low-density lipoprotein-cholesterol life-years, sum of stenosis severity to the estimated risk, and PCS to the estimated risk and low-density lipoprotein-cholesterol life-years. CTA findings induced a positive change in patients' care and in their estimated risk.
Conclusion:
Coronary artery atherosclerosis is highly prevalent in asymptomatic patients with FH and it is independently associated to cardiovascular risk. More advanced disease on CTA was associated with subsequent intensification of therapy and reduction of estimated risk. Further longitudinal studies are required to know if these findings might improve the risk stratification in patients with FH.
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