Extracoronary atherosclerosis in familial hypercholesterolemia
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P Rubba1, B De Simone, A Postiglione
1Institute of Internal Medicine and Metabolic Diseases, University of Naples, Italy.
Insights
Familial hypercholesterolemia (FH) patients show increased arterial abnormalities, particularly in iliac and carotid arteries. These vascular issues are linked to lower HDL-cholesterol and smoking in FH individuals.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Metabolic Disorders
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol levels.
- Accelerated atherosclerosis is a known complication of FH, increasing cardiovascular risk.
- Early detection of vascular damage in FH patients is crucial for timely intervention.
Purpose of the Study:
- To investigate the prevalence and characteristics of vascular abnormalities in patients with familial hypercholesterolemia.
- To compare arterial lesion frequency in FH patients versus a control group.
- To identify factors associated with arterial lesions in FH.
Main Methods:
- Doppler ultrasound was used to assess ankle/arm systolic pressure index and evaluate carotid and iliac arteries.
- Serum lipoproteins were analyzed.
- Spectral analysis was employed for echo Doppler examinations.
Main Results:
- 6.5% of legs showed ankle/arm pressure index < 0.95, indicating stenosis.
- 12.1% of examined arteries (carotid, iliac) had detectable abnormalities.
- Iliac and internal carotid artery lesions were significantly more frequent in FH patients (P < 0.01).
- FH patients with lesions were older (mean 45.3 years) than those without (mean 30.7 years).
- Patients with lesions had lower HDL-cholesterol and were more likely to be smokers.
Conclusions:
- Familial hypercholesterolemia is associated with a higher prevalence of arterial lesions in the iliac and carotid arteries.
- Vascular abnormalities in FH patients are linked to lower HDL-cholesterol levels and smoking.
- These findings highlight the importance of comprehensive vascular assessment in FH management.
Abstract:
Sixty-two patients (31 males, 31 females) with familial hypercholesterolemia (FH) underwent a vascular examination by Doppler ultrasound. The ankle/arm systolic pressure index was determined, and serum lipoproteins were analyzed. Eight of 124 legs examined (6.5%) showed an ankle/arm pressure index less than 0.95, suggesting flow reducing stenosis. Common carotid, internal carotid, and iliac arteries were evaluated by echo Doppler examination with spectral analysis. Forty-five of the 372 arteries examined (12.1%) had detectable abnormalities at echo Doppler examination. Iliac and internal carotid artery lesions were significantly (P less than 0.01) more frequent among FH patients than in a control group (30 men, 20 women) comparable for sex and age. The mean age of the patients with heterozygous FH and detectable arterial lesions was 45.3 years and that of those without lesions 30.7 years (P less than 0.05). When 14 patients with heterozygous FH and arterial lesions were compared to another 14 without lesions and matched for age and gender, it was found that patients with lesions had on average lower concentrations of HDL-cholesterol, and that 10 of 14 cases were actual smokers.