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Coronary Artery Disease Prediction in Korean Patients with Familial Hypercholesterolemia: Analysis Involving
Hyeonji Lee1, Eui Seob Sheen2, Seungmin Seok1
1Graduate School, Yonsei University, Seoul, Korea.
Insights
Traditional risk factors like hypertension and high-density lipoprotein-cholesterol (HDL-C) predict coronary artery disease (CAD) in familial hypercholesterolemia (FH) patients. A new prediction model shows good performance, but cholesterol efflux capacity (CEC) was not a significant predictor.
Area of Science:
- Cardiovascular Medicine
- Genetics and Genomics
- Biochemistry
Background:
- Familial hypercholesterolemia (FH) significantly elevates the risk of coronary artery disease (CAD).
- Accurate prediction of CAD in FH patients is crucial for clinical management and preventative strategies.
Purpose of the Study:
- To identify key predictors of CAD in Korean patients diagnosed with familial hypercholesterolemia.
- To develop and validate an effective risk prediction model for CAD tailored to this specific population.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 245 Korean FH patients.
- CAD diagnosis confirmed by coronary stenosis (≥50%) via angiography.
- Cholesterol efflux capacity (CEC) measured using a cellular assay; predictor identification via multivariable logistic regression.
Main Results:
- Identified predictors of CAD included age, hypertension, low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C).
- An alternative model also found age, hypertension, body mass index (BMI), and apolipoprotein A1 (ApoA1) to be predictive.
- Cholesterol efflux capacity (CEC) did not show significant predictive value for CAD.
- The best-performing CAD prediction model incorporated six variables, achieving an area under the curve (AUC) of 0.878.
Conclusions:
- Established risk factors such as hypertension and HDL-C levels are significant predictors of CAD in Korean FH patients.
- Cholesterol efflux capacity (CEC) was not found to be a significant predictor in this cohort.
- The developed CAD risk prediction model demonstrates robust performance for the Korean FH population.
Purpose:
Patients with familial hypercholesterolemia (FH) are at high risk of coronary artery disease (CAD), and its prediction is of great clinical importance. This study aimed to identify predictors of CAD and construct an effective risk prediction model for Korean patients with FH.
Materials And Methods:
Clinical and laboratory data of 245 patients were collected from the Korean FH registry. CAD was defined as ≥50% coronary stenosis on invasive or computed tomographic angiography. The cholesterol efflux capacity (CEC) was measured using J774A1 cells and radiolabeled cholesterol. Predictors of CAD were identified by multivariable logistic regression analysis, and the best-performing prediction model was determined based on its statistical indices.
Results:
The participants' mean age was 49.1 years; 92 (37.6%) were male, and 41 (16.7%) had CAD. Age [odds ratio (OR) 1.05; p=0.02], hypertension (OR 7.28; p<0.0001), low-density lipoprotein-cholesterol (OR 1.60; p=0.02), and high-density lipoprotein-cholesterol (HDL-C) (OR 0.93; p=0.002) were identified as predictors of CAD in the multivariable analysis. In another analysis, age, hypertension, body mass index (OR 1.16; p=0.03), and apolipoprotein A1 (OR 0.97; p=0.002) were predictive of CAD. CEC did not have a significant predictive value. The best-performing CAD prediction model included six clinical and laboratory variables, with an area under the curve of 0.878. The effects of hypertension, smoking, and HDL-C were particularly influential.
Conclusion:
Traditional risk factors, including hypertension and HDL-C, were predictors of CAD in Korean patients with FH, whereas CEC was not. The resulting CAD prediction model demonstrated satisfactory performance in this population.
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