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Published on: July 18, 2014
Subclinical atherosclerosis in patients with cyanotic congenital heart disease
Julie Bjerre Tarp1, Mathias Holm Sørgaard2, Christina Christoffersen3
1Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Denmark.
Insights
Adults with cyanotic congenital heart disease (CCHD) show no increased risk of atherosclerosis compared to controls. This suggests that athero-preventive strategies are crucial for managing their long-term cardiovascular health.
Area of Science:
- Cardiology
- Vascular Biology
- Congenital Heart Disease
Background:
- Improved survival in cyanotic congenital heart disease (CCHD) leads to an aging population at risk for acquired heart disease.
- Previous studies suggested a protective effect against atherosclerosis in CCHD patients, but lacked robust data.
- This study aimed to determine the prevalence of subclinical atherosclerosis in a larger CCHD cohort.
Purpose of the Study:
- To investigate the prevalence of subclinical atherosclerosis in adult CCHD patients.
- To compare atherosclerosis markers between CCHD patients and matched controls.
- To assess cardiovascular risk factors in this growing CCHD population.
Main Methods:
- A comparative study involving 74 adult CCHD patients and 74 matched controls from four countries.
- Coronary artery atherosclerosis assessed via computed tomography (CT) for coronary artery calcification (CAC) score.
- Carotid artery atherosclerosis evaluated using ultrasound for plaque thickness (cPT-max) and intima-media thickness (CIMT).
- Lipid status analyzed using ultracentrifugation.
Main Results:
- No significant differences were found in CAC score > 0 (21% vs. 19%), carotid plaques (19% vs. 9%), cPT-max (2.3 mm vs. 2.8 mm), or CIMT (0.61 mm vs. 0.61 mm) between CCHD patients and controls.
- Lipoprotein concentrations also showed no significant differences between the groups.
- The study included a comparable number of men and women, with median ages around 50 years.
Conclusions:
- Adults with CCHD exhibit similar cardiovascular risk factor profiles and subclinical atherosclerosis measures compared to their healthy counterparts.
- Despite similar current risk, the increasing life expectancy of CCHD patients necessitates proactive athero-preventive strategies.
- Integrating atherosclerosis prevention into the clinical management of CCHD is essential for long-term health outcomes.
Introduction:
Survival in patients with cyanotic congenital heart disease (CCHD) has improved dramatically. The result is an ageing population with risk of acquired heart disease. Previous small uncontrolled studies suggested that these patients are protected against the development of atherosclerosis. To test this hypothesis, we sought to determine the prevalence of subclinical atherosclerosis in a larger population of patients with CCHD.
Method:
We compared the prevalence of subclinical atherosclerosis in adult CCHD patients from Denmark, Sweden, Norway and Australia, with that in age-, sex-, smoking status-, and body mass index matched controls. Coronary artery atherosclerosis was assessed on computed tomography with coronary artery calcification (CAC) score. Subclinical atherosclerosis was defined by CAC-score > 0. Carotid artery atherosclerosis was evaluated using ultrasound by measuring carotid plaque thickness (cPT-max) and carotid intima media thickness (CIMT). Lipid status was evaluated as an important atherosclerotic risk factor.
Results:
Seventy-four patients with CCHD (57% women, median age 49.5 years) and 74 matched controls (57% women, median age 50.0 years) were included. There were no differences between the groups in: CAC-score > 0 (21% vs. 19%, respectively; p = 0.8), carotid plaques (19% vs. 9%, respectively; p = 0.1), cPT-max (2.3 mm vs. 2.8 mm, respectively; p = 0.1) or CIMT (0.61 mm vs. 0.61 mm, respectively; p = 0.98). And further no significant differences in lipoprotein concentrations measured by ultracentrifugation.
Conclusion:
Young adults with CCHD have similar cardiovascular risk factor profiles and measures of subclinical atherosclerosis, compared with controls. Given their increasing life expectancies, athero-preventive strategies should be an important part of their clinical management.
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