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Published on: May 21, 2017
Aortic valve calcium score in hypercholesterolemic patients with and without low-density lipoprotein receptor gene
Rafal Gałąska1, Dorota Kulawiak-Gałąska2, Magdalena Chmara3
11st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
Insights
Patients with familial hypercholesterolemia and a low-density lipoprotein receptor gene mutation (LDLR-M) have significantly higher aortic valve calcium scores (AVCS) than those without the mutation (LDLR-WT). LDLR mutation is an independent risk factor for increased AVCS.
Area of Science:
- Cardiology
- Genetics
- Radiology
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder characterized by high LDL cholesterol.
- Low-density lipoprotein receptor (LDLR) gene mutations are a common cause of FH.
- Aortic valve calcification (AVC) is a serious complication of hypercholesterolemia.
Purpose of the Study:
- To compare aortic valve calcium scores (AVCS) between patients with FH and LDLR gene mutations (LDLR-M) versus those with hypercholesterolemia but without LDLR mutations (LDLR-WT).
- To determine if LDLR mutation is an independent predictor of high AVCS.
Main Methods:
- Retrospective study comparing 72 LDLR-M patients and 50 LDLR-WT patients.
- All patients underwent CT scans for coronary calcium scoring.
- Aortic valve calcium scores (AVCS) were measured and compared between groups.
Main Results:
- AVCS was significantly higher in the LDLR-M group (13.8 ± 37.9) compared to the LDLR-WT group (0.94 ± 3.1) (p=0.03).
- LDLR mutation was a strong predictor of high AVCS (OR 7.83, p=0.002), independent of traditional risk factors.
- Age and systolic blood pressure were also significant predictors of high AVCS.
Conclusions:
- Patients with LDLR gene mutations exhibit increased aortic valve calcification.
- LDLR mutation is an independent risk factor for elevated AVCS, potentially due to LDLR's role in aortic valve calcification.
- These findings highlight the importance of genetic screening in hypercholesterolemia management.
Abstract:
The aim of this study was a comparison of aortic valve calcium score (AVCS) between patients with hypercholesterolemia and genetic diagnosis of familial hypercholesterolemia with low-density lipoprotein receptor gene mutation (LDLR-M group), versus patients with hypercholesterolemia without LDLR gene mutation (LDLR-WT group). A total of 72 LDLR-M patients and 50 LDLR-WT patients were enrolled in the study and underwent CT as a part of an assessment of coronary calcium scoring. AVCS was determined and compared between the two patient groups. AVCS was significantly higher in the LDLR-M group in comparison to the LDLR-WT group (13.8 ± 37.9 vs. 0.94 ± 3.1, p = 0.03). The Yates' chi-squared test for independence revealed that LDLR mutation and AVCS were significantly dependable (Chi^2 = 6.106, p = 0.013). The LDLR mutation was a strong predictor of a high AVCS (OR 7.83, 95% CI 2.08-29.50, p = 0.002) on multivariate regression analysis. Among the traditional risk factors, age (odds ratio 1.12, 95% CI 1.05-1.18, p<0.001) and SBP (OR 1.04, 95% CI 1.00-1.07, p = 0.045) were also significant for high result of AVCS. An assessment of computed tomography calcium scores showed that LDLR-M patients have increased AVCS in comparison to those with LDLR-WT. In addition, LDLR mutation can be considered as an independent risk factor of having high AVSC even after adjustment for risk factors including cholesterol levels. This may result from the associated process connected with the regulatory role of LDLR in evolution of aortic valve calcifications.
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