Assessments of Carotid Artery Plaque Burden in Patients With Familial Hypercholesterolemia.

Although both carotid intima-media thickness (cIMT) and carotid plaque score (cPS) determined by carotid ultrasonography reflect the severity of coronary atherosclerosis, there are few reports on direct comparisons of their clinical utilities in patients with familial hypercholesterolemia (FH). We aimed (1) to compare the clinical utilities of these measurements and (2) to estimate the onset and progression of carotid atherosclerosis in patients with FH. We examined 225 patients with FH (126 males; mean age, 51 ± 18 years) who underwent carotid ultrasonography. We assessed baseline characteristics including lipid levels, other traditional risk factors, and the presence of coronary artery disease (CAD) as well as mean cIMT and cPS. Multivariate logistic analysis revealed that cPS was significantly associated with CAD (odds ratio [OR] 1.22, 95% confidence interval (CI) 1.10-1.37, p = 0.00036), whereas cIMT was not (OR 1.26, 95% CI 0.15 to 11.76, p = 0.84). Adding cPS information to other traditional risk factors improved the risk discrimination of CAD (C-index 0.887 vs 0.909, p = 0.030), whereas adding cIMT information did not (C-index 0.887 vs 0.893, p = 0.33). Regression equations were Y = 0.219X - 3.74 (r = 0.65, p < 0.001) in male and Y = 0.215X - 5.47 (r = 0.72, p < 0.001) in female patients with FH. In conclusion, cPS may provide superior risk stratification in patients with FH compared with cIMT. On average, carotid atherosclerosis may develop at 17 and 26 years of age in male and female patients with heterozygous FH, respectively.