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Coronary angiographic characteristics in Japanese patients with heterozygous familial hypercholesterolemia
Insights
Heterozygous familial hypercholesterolemia (FH) significantly increases coronary atherosclerosis and myocardial infarction risk, particularly in younger males. FH patients exhibit higher cholesterol levels and coronary ectasia compared to non-FH individuals.
Area of Science:
- Cardiology
- Genetics
- Metabolic Disorders
Background:
- Familial hypercholesterolemia (FH) is an inherited disorder characterized by high levels of low-density lipoprotein cholesterol.
- FH significantly elevates the risk of premature cardiovascular disease, including coronary artery disease.
Purpose of the Study:
- To investigate and compare coronary angiographic findings and cardiovascular event incidence in patients with and without heterozygous familial hypercholesterolemia (FH).
- To analyze the influence of age and sex on coronary atherosclerosis and myocardial infarction in FH patients.
Main Methods:
- Coronary angiographic findings were analyzed in 51 FH patients and 279 non-FH patients.
- Coronary stenosis index, percentage of stenosis, myocardial infarction incidence, and lipid profiles were compared.
- Subgroup analyses were performed based on age (<50 and >50 years) and sex.
Main Results:
- FH patients had a nearly threefold higher coronary stenosis index and over 75% stenosis vessel subset, and nearly twice the incidence of myocardial infarction compared to non-FH patients.
- FH patients exhibited significantly higher total cholesterol and lipoprotein fractions (except HDL-cholesterol).
- In FH patients under 50, males showed significantly higher coronary angiogram parameters and myocardial infarction incidence than females; this difference diminished in those over 50. Coronary ectasia was more prevalent in FH patients (18% vs 2%) and predominantly affected males.
Conclusions:
- Heterozygous FH is strongly associated with increased coronary atherosclerosis, myocardial infarction, and coronary ectasia.
- Sex differences in cardiovascular risk manifestation exist in younger FH patients but are less pronounced in older individuals.
- Lower HDL-cholesterol levels were observed in males compared to females within the FH group.
Abstract:
Coronary angiographic findings were analyzed in 51 consecutive patients (36 males and 15 females) with heterozygous familial hypercholesterolemia (FH) and 279 consecutive patients (216 males and 63 females) without FH (non-FH). The coronary stenosis index and over 75% stenosis vessel subset were almost three times as high in the FH group. The incidence of myocardial infarction was almost twice as high in the FH group. Levels of total cholesterol and its lipoprotein fractions, except HDL-cholesterol, were almost twice as high in the FH group. In the FH group aged under 50 years, the two parameters of coronary angiogram and the incidence of myocardial infarction were significantly higher in males than in females. However, in the group aged over 50 years, all three parameters were not significantly different between those in males and females. The level of HDL-cholesterol was significantly lower in males than in females. A significantly higher incidence (18%) of coronary ectasia was observed in the FH group compared with the incidence (2%) in non-FH. All patients with coronary ectasia were males, except one female with FH. On comparison of the males among the FH patients with those among the non-FH patients matched for total cholesterol, age and other risk factors, the FH patients were associated with a significantly higher degree of coronary atherosclerosis and lower level of HDL-cholesterol. Seven FH patients with a normal coronary angiogram were observed. However, any factors as regards age, total cholesterol, HDL-cholesterol and Achilles tendon thickness failed to distinguish between the FH patients with a normal coronary angiogram and those without.(ABSTRACT TRUNCATED AT 250 WORDS)