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Development of coronary atherosclerosis in asymptomatic heterozygous patients with familial hypercholesterolemia
1Department of Laboratory Medicine, Niigata University School of Medicine.
Insights
Coronary atherosclerosis progresses with age in asymptomatic familial hypercholesterolemia (FH) patients. Long-term cholesterol-lowering therapy shows promise for preventing coronary artery disease (CAD) in this high-risk group.
Area of Science:
- Cardiology
- Atherosclerosis Research
- Preventative Medicine
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol.
- Atherosclerosis, the buildup of plaque in arteries, is a major risk factor for coronary artery disease (CAD).
- Early detection and prevention strategies are crucial for FH patients to mitigate cardiovascular risks.
Purpose of the Study:
- To investigate the development of coronary atherosclerosis in asymptomatic patients with familial hypercholesterolemia (FH).
- To evaluate the efficacy of long-term cholesterol-lowering therapy in the primary prevention of coronary artery disease (CAD) in FH patients.
Main Methods:
- Coronary angiography was performed on 13 heterozygous FH patients (34-66 years old).
- Coronary atherosclerosis extent was quantified using a coronary score (CS) based on American Heart Association segments.
- Patients were followed up for an average of 5.8 years, with most receiving cholesterol-lowering agents.
Main Results:
- Coronary atherosclerosis (CS) was significantly higher in men than women, despite men being younger.
- In men, CS showed a significant positive correlation with age.
- The single untreated patient developed CAD, while 11 of 12 treated patients did not, suggesting a protective effect of therapy.
Conclusions:
- Coronary atherosclerosis progresses with age in asymptomatic FH patients.
- Long-term cholesterol-lowering therapy may be effective in preventing CAD in this population.
- Further research is warranted to confirm the long-term benefits of lipid-lowering interventions for primary CAD prevention in FH.
Abstract:
To determine whether coronary atherosclerosis develops with age in asymptomatic patients with familial hypercholesterolemia (FH) and whether long-term cholesterol-lowering therapy is effective for primary prevention of coronary artery disease (CAD) in such patients, 13 patients with heterozygous FH (10 men, 3 women, aged 34 to 66 years) were examined by coronary angiography, and followed up for 5.8 +/- 3.4 years. The extent of coronary atherosclerosis was expressed as the coronary score (CS) by scoring (0 to 5) points in each of 15 American Heart Association segments. The mean CS was 2.4 times higher in men than in women (11.5 +/- 7.9 vs 4.7 +/- 4.2) although the mean age was lower in the former than in the latter (51.2 +/- 8.4 vs 57.7 +/- 0.6 years). In men, CS correlated significantly with age (CS = 0.682 x age-24.4; r = 0.800, p < 0.01). All patients except one had received cholesterol-lowering agents throughout the follow-up period. The untreated patient developed CAD 7 years later. One treated patient also developed CAD, but within 6 months of enrollment in this study. The other 11 treated patients did not develop CAD. Reexamination by coronary angiography in two of these patients revealed no significant progression after 6-year treatment. Coronary atherosclerosis develops with age in asymptomatic FH patients and long-term cholesterol-lowering therapy may be effective for primary prevention of CAD in such patients.