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Triple Assessments of Atherosclerosis in Patients With Heterozygous Familial Hypercholesterolemia
Hayato Tada1, Nobuko Kojima1, Kan Yamagami1
1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Insights
Atherosclerosis develops early in heterozygous familial hypercholesterolemia (HeFH). Triple assessments of carotid plaque, coronary plaque, and coronary artery calcium (CAC) aid in early detection and risk stratification for cardiovascular events in HeFH patients.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Medical Imaging
Background:
- Limited data exist on the timing and impact of atherosclerosis assessment in patients with heterozygous familial hypercholesterolemia (HeFH).
- Understanding early atherosclerotic changes is crucial for timely intervention in HeFH.
- HeFH is a genetic disorder characterized by high LDL cholesterol levels, predisposing individuals to premature cardiovascular disease.
Purpose of the Study:
- To determine the age of onset for atherosclerotic changes in HeFH patients.
- To evaluate the utility of triple assessments (carotid plaque, coronary plaque, coronary artery calcium) for risk stratification in HeFH.
- To identify the relationship between age and atherosclerosis progression in HeFH.
Main Methods:
- Retrospective review of 622 HeFH patients (primary prevention) from Kanazawa University Hospital (2000-2020).
- Triple atherosclerosis assessment including carotid plaque, coronary plaque, and coronary artery calcium (CAC) scores.
- Cox proportional hazard model used to determine risk factors for coronary heart disease events; regression analysis plotted plaque scores against age.
Main Results:
- Age was independently associated with coronary heart disease events in HeFH patients.
- Regression equations revealed significant associations between age and atherosclerosis burden (carotid plaque, coronary plaque, CAC) in both men and women.
- Significant differences in cardiovascular events were observed based on atherosclerotic burden, highlighting the utility of triple assessments.
Conclusions:
- Carotid plaque, coronary plaque, and CAC may develop as early as ages 17, 26, and 31 in males, and 30, 36, and 40 in females with HeFH, respectively.
- Triple atherosclerosis assessments are valuable tools for risk stratification in HeFH patients.
- Early and comprehensive atherosclerosis assessment is recommended for individuals with HeFH to guide preventative strategies.
Background:
Data on the appropriate timing and impact of atherosclerosis assessment in patients with heterozygous familial hypercholesterolemia (HeFH) are limited.
Objectives:
The authors aimed to determine when atherosclerotic changes occur and the utility of triple assessments of carotid plaque, coronary plaque, and coronary artery calcium (CAC) in patients with HeFH.
Methods:
Data from patients with HeFH in the primary prevention setting admitted to Kanazawa University Hospital between 2000 and 2020 who underwent triple atherosclerosis assessment and were followed up were retrospectively reviewed (n = 622, male = 306, mean age = 54 ± 13 years). Risk factors for coronary heart disease events were determined using the Cox proportional hazard model. Carotid plaque, coronary plaque, and CAC scores were plotted against age.
Results:
We found that the age was independently associated with coronary heart disease events. Regression equations of carotid plaque, coronary plaque, and CAC scores against age were Y = 0.12X - 2.07 (β coefficient = 0.12 [95% CI: 0.09-0.15]; r2 = 0.12), Y = 0.36X - 9.30 (β coefficient = 0.36 [95% CI: 0.26-0.46]; r2 = 0.14), and Y = 2.48X - 77.23 (β coefficient = 0.07 [95% CI: 0.04-0.10]; r2 = 0.23) in men and Y = 0.12X - 3.60 (β coefficient = 0.12 [95% CI: 0.08-0.16]; r2 = 0.18), Y = 0.33X - 11.75 (β coefficient = 0.33 [95% CI: 0.29-0.37]; r2 = 0.17), and Y = 2.23X - 89.47 (β coefficient = 0.09 [95% CI: 0.06-0.12]; r2 = 0.34) in women, respectively. Significant differences of cardiovascular events were observed among the groups according to atherosclerotic burden.
Conclusions:
On average, carotid plaque, coronary plaque, and CAC may develop at ages 17, 26, and 31 years in male patients and 30, 36, and 40 years in female patients with HeFH, respectively, based on regression equations. Furthermore, triple assessments help in risk stratification.
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