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The prevalence of peripheral vascular disease in familial hypercholesterolaemia
A A Kroon1, N Ajubi, W N van Asten
1Department of Internal Medicine, University Hospital Nijmegen, The Netherlands.
Insights
Peripheral vascular disease (PVD) is more common in familial hypercholesterolaemia (FH) patients, particularly those with coronary artery disease (CAD). This study found a higher prevalence of PVD in FH patients than previously assumed.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Vascular Biology
Background:
- Familial hypercholesterolaemia (FH) is a genetic disorder characterized by high levels of low-density lipoprotein (LDL) cholesterol.
- Peripheral vascular disease (PVD) and coronary artery disease (CAD) are significant complications associated with cardiovascular risk factors.
Purpose of the Study:
- To determine the prevalence of haemodynamically significant PVD in patients with FH.
- To investigate the relationship between PVD, lipoproteins, general risk factors, and the presence of CAD in FH patients.
Main Methods:
- A case-control study was conducted comparing 68 FH patients with 27 matched control subjects.
- PVD was assessed using ankle/arm blood pressure ratios and Doppler-derived blood flow velocities.
- CAD diagnosis was based on clinical assessment.
Main Results:
- Haemodynamically significant PVD was found in 31% of FH patients compared to 3.7% of controls.
- PVD was present in 50% of FH patients with CAD, with a relative risk of 3.2.
- Higher mean arterial blood pressure was observed in FH patients with PVD.
Conclusions:
- Haemodynamically significant PVD is more prevalent in FH patients than generally assumed, especially in those with co-existing CAD.
- PVD can be an early manifestation of vascular disease in FH patients.
- No direct relationship between lipoprotein levels and PVD prevalence was demonstrated in this study.
Objectives:
In patients with familial hypercholesterolaemia (FH), the prevalence of haemodynamically significant peripheral vascular disease (PVD) was measured in relation to lipoproteins, general risk factors and the presence of coronary artery disease (CAD).
Design:
A case control study.
Setting:
The outpatient lipid clinic of a university hospital (tertiary referral centre).
Subjects:
Patients with heterozygous FH [n = 68; age 45.8 +/- 11.6 years; untreated LDL-cholesterol 9.2 +/- 2.0 mmol L-1] were compared with control subjects matched for gender, age, weight, smoking and presence of hypertension [n = 27; age 44.0 years; LDL-cholesterol 3.8 +/- 1.3 mmol L-1].
Main Outcome Measures:
PVD was assessed during cholesterol-lowering treatment using ankle/arm blood pressure ratios and analyses of Doppler-derived blood flow velocities in the femoral artery at rest and during reactive hyperaemia. The diagnosis of CAD was assessed clinically.
Results:
Haemodynamically significant PVD was found in 21 (31%) FH patients and in one (3.7%) control subject, predominantly localized in the femoro-popliteal vessels. CAD was present in 30 (44.1%) FH patients and in one (3.7%) control subject. PVD could be demonstrated in 50% of FH patients with CAD [relative risk 3.2 (95% CI 1.4-7.2)] and in 19% as the first manifestation of vascular disease. Males and females were equally affected. Mean arterial blood pressure of FH patients with PVD was higher compared to FH patients without PVD.
Conclusions:
Haemodynamically significant PVD appears to be more prevalent in FH patients than is generally assumed, especially in those with CAD. A relation with lipoprotein levels could not be demonstrated.