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Coronary Artery Calcium and Cardiovascular Events in Patients With Familial Hypercholesterolemia Receiving Standard

Marcio H Miname1, Marcio Sommer Bittencourt2, Sérgio R Moraes1

  • 1Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.

JACC. Cardiovascular Imaging
|November 19, 2018
PubMed

Insights

Coronary artery calcium (CAC) scores effectively predict atherosclerotic cardiovascular disease (ASCVD) events in familial hypercholesterolemia (FH) patients on lipid-lowering therapy. Higher CAC scores indicate increased ASCVD risk, aiding in personalized treatment strategies.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Imaging

Background:

  • Familial hypercholesterolemia (FH) significantly increases the risk of premature atherosclerotic cardiovascular disease (ASCVD).
  • The clinical presentation of ASCVD in FH patients is variable, necessitating refined risk stratification tools.
  • Coronary artery calcium (CAC) scoring is a valuable marker for subclinical atherosclerosis burden.

Purpose of the Study:

  • To assess the predictive value of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) events.
  • To evaluate CAC in asymptomatic primary prevention patients with molecularly proven heterozygous familial hypercholesterolemia (FH).
  • To determine the role of CAC in patients already receiving standard lipid-lowering therapy.

Main Methods:

  • Prospective follow-up of 206 FH subjects who underwent CAC measurement.
  • Multivariate analysis was employed to evaluate the association between CAC and ASCVD events.
  • Study included patients with a mean age of 45 years and high baseline LDL cholesterol levels.

Main Results:

  • Coronary artery calcium (CAC) was detected in 51% of the study participants.
  • A total of 15 ASCVD events (7.2%) occurred during a median follow-up of 3.7 years.
  • Log(CAC score + 1) was independently associated with incident ASCVD events (HR: 3.33; p=0.001), with event rates increasing significantly with higher CAC scores.

Conclusions:

  • Coronary artery calcium (CAC) is an independent predictor of ASCVD events in familial hypercholesterolemia (FH) patients on lipid-lowering therapy.
  • CAC scoring can enhance risk stratification for FH patients, identifying those who may benefit from intensified treatment.
  • This study supports the use of CAC to refine risk assessment in primary prevention for FH individuals.
Abstract

Keywords:
PCSK9atherosclerosiscomputed tomographycoronary calcificationfamilial hypercholesterolemiarisk factorsstatins

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