Antonio Gallo1, Philippe Giral2, Alain Carrié3, Valérie Carreau4, Sophie Béliard5, Randa Bittar6, Marianna Maranghi7, Marcello Arca7, Philippe Cluzel8, Alban Redheuil8, Eric Bruckert2, David Rosenbaum9. 1. Unité de Prévention Cardiovasculaire, Service d'Endocrinologie-Métabolisme, Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'imagerie Biomédicale, Paris, France; Atherosclerosis Research Unit, Diabetes and Cardiovascular Prevention Unit, Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. Electronic address: antoniogallo.md@gmail.com. 2. Unité de Prévention Cardiovasculaire, Service d'Endocrinologie-Métabolisme, Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie, Paris, France; Dyslipoproteinemia and Atherosclerosis Research Unit, UMRS 939, National Institute for Health and Medical Research (INSERM) and Pierre et Marie Curie University (UPMC - Paris VI), Paris, France. 3. Molecular and Chromosomic genetic Center, INSERM U939; Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 4. Unité de Prévention Cardiovasculaire, Service d'Endocrinologie-Métabolisme, Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie, Paris, France. 5. Service de Nutrition, Maladies métaboliques et Endocrinologie, Hôpital Conception, Marseille, France. 6. Biochemistry Functional Unit for Metabolic Disease Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 7. Atherosclerosis Research Unit, Diabetes and Cardiovascular Prevention Unit, Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. 8. Sorbonne Universités, UPMC Université Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'imagerie Biomédicale, Paris, France; Département d'imagerie cardiovasculaire et de radiologie interventionnelle, Pôle Imagerie - Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Imaging Core Lab, Institute of Cardiometabolism and Nutrition, ICAN, Paris, France. 9. Unité de Prévention Cardiovasculaire, Service d'Endocrinologie-Métabolisme, Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'imagerie Biomédicale, Paris, France; Imaging Core Lab, Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.
Abstract
BACKGROUND: The identification of high-risk patients with heterozygous familial hypercholesterolemia (HeFH) that may benefit from early treatment is challenging. Coronary Artery Calcification (CAC) score accounts for coronary atherosclerotic burden. It has proven its accuracy in cardiovascular risk assessment in the general population but data in HeFH are lacking. OBJECTIVE: The aim of our study was to assess CAC prevalence and its relationship with lifelong cholesterol exposure, calculated by total cholesterol burden (TCB) in patients with HeFH. METHODS: A total of 112 HeFH patients (50% males, median age 45 years) regularly followed-up since diagnosis were prospectively recruited at Pitié-Salpêtrière Hospital, Paris, France. CAC score was assessed using noncontrast multi-detector computed tomography. TCB was calculated as total cholesterol (TC) × age at diagnosis plus annually assessed TC. RESULTS: The prevalence of CAC was 58%. Patients without CAC showed lower TCB than patients with CAC (298 ± 110 vs 417.9 ± 89 mmol-years/L, P < .001). Among patients aged <45 years (n = 56), 39% exhibited CAC and a higher TCB compared with patients without CAC (352 ± 71 vs 255 ± 88 mmol-years/L, P < .001) due to higher TC levels at diagnosis (10.2 ± 2 vs 8.7 ± 2 mmol/L, P = .01). Multivariate analysis indicated that TCB was independently associated to CAC. CONCLUSIONS: Asymptomatic HeFH subjects exhibit early coronary atherosclerosis directly associated with TCB burden. CAC score may be useful to identify higher risk HeFH patients who can benefit from earlier and more aggressive treatment.
BACKGROUND: The identification of high-risk patients with heterozygous familial hypercholesterolemia (HeFH) that may benefit from early treatment is challenging. Coronary Artery Calcification (CAC) score accounts for coronary atherosclerotic burden. It has proven its accuracy in cardiovascular risk assessment in the general population but data in HeFH are lacking. OBJECTIVE: The aim of our study was to assess CAC prevalence and its relationship with lifelong cholesterol exposure, calculated by total cholesterol burden (TCB) in patients with HeFH. METHODS: A total of 112 HeFH patients (50% males, median age 45 years) regularly followed-up since diagnosis were prospectively recruited at Pitié-Salpêtrière Hospital, Paris, France. CAC score was assessed using noncontrast multi-detector computed tomography. TCB was calculated as total cholesterol (TC) × age at diagnosis plus annually assessed TC. RESULTS: The prevalence of CAC was 58%. Patients without CAC showed lower TCB than patients with CAC (298 ± 110 vs 417.9 ± 89 mmol-years/L, P < .001). Among patients aged <45 years (n = 56), 39% exhibited CAC and a higher TCB compared with patients without CAC (352 ± 71 vs 255 ± 88 mmol-years/L, P < .001) due to higher TC levels at diagnosis (10.2 ± 2 vs 8.7 ± 2 mmol/L, P = .01). Multivariate analysis indicated that TCB was independently associated to CAC. CONCLUSIONS: Asymptomatic HeFH subjects exhibit early coronary atherosclerosis directly associated with TCB burden. CAC score may be useful to identify higher risk HeFH patients who can benefit from earlier and more aggressive treatment.
Authors: Maria Mytilinaiou; Ioannis Kyrou; Mike Khan; Dimitris K Grammatopoulos; Harpal S Randeva Journal: Front Pharmacol Date: 2018-07-12 Impact factor: 5.810
Authors: Sarah Béland-Bonenfant; Martine Paquette; Manon Fantino; Lucienne Bourque; Nathalie Saint-Pierre; Alexis Baass; Sophie Bernard Journal: CJC Open Date: 2020-09-14