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Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia

Hayato Tada1, Nobuko Kojima1, Kan Yamagami1

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.

European Heart Journal Open
|May 16, 2023
PubMed

Insights

Coronary artery calcium (CAC) scores significantly predict cardiovascular disease (CVD) events in patients with heterozygous familial hypercholesterolaemia (HeFH). Adding CAC to traditional risk factors improves CVD event risk assessment for this high-risk group.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Imaging

Background:

  • Familial hypercholesterolaemia (HeFH) is a genetic disorder leading to high LDL cholesterol and premature cardiovascular disease (CVD).
  • Accurate risk stratification is crucial for primary prevention in HeFH patients.
  • Coronary artery calcium (CAC) scoring is an established tool for assessing atherosclerosis burden.

Purpose of the Study:

  • To investigate the association between CAC scores and the incidence of CVD events in patients with HeFH.
  • To evaluate the incremental value of CAC scoring in risk stratification beyond conventional risk factors for HeFH patients.

Main Methods:

  • Retrospective analysis of 622 HeFH patients who underwent CAC measurement and were followed for a median of 13.2 years.
  • Cox proportional hazard models were used to identify risk factors for CVD events.
  • Multivariate analysis assessed the predictive value of log (CAC score + 1) and its impact on risk discrimination.

Main Results:

  • A total of 132 CVD events were observed.
  • Event rates per 1000 person-years increased significantly with higher CAC scores (1.2 for CAC=0, 17.0 for CAC=1-100, 78.8 for CAC>100).
  • Log (CAC score + 1) was an independent predictor of CVD events (HR: 3.24, P < 0.0001), and improved risk discrimination (C-statistics: 0.833-0.934).

Conclusions:

  • CAC scoring is a valuable tool for risk stratification in patients with HeFH.
  • Incorporating CAC scores enhances the prediction of CVD events in primary prevention settings for HeFH individuals.
  • CAC assessment can guide more precise management strategies for HeFH patients at risk of cardiovascular events.
Abstract

Keywords:
Coronary calcium scoreFamilial hypercholesterolaemiaGeneticsLDL cholesterolLDL receptor

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