Leopoldo Pérez de Isla1, Rodrigo Alonso2, Ovidio Muñiz-Grijalvo3, José Luis Díaz-Díaz4, Daniel Zambón5, José Pablo Miramontes6, Francisco Fuentes7, José Juan Gómez de Diego8, Aurora González-Estrada3, Nelva Mata9, Adriana Saltijeral10, Manuel Barreiro11, Marta Tomás12, Raimundo de Andrés13, Rosa Argüeso14, Maria Pilar Serrano Gotarredona15, Silvia Navarro Herrero15, Rosario J Perea Palazón16, Teresa M de Caralt16, Luisa Arrojo Suárez de Centi17, Svetlana Zhilina6, Simona Espejo Pérez18, Teresa Padró19, Pedro Mata20. 1. Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain. Electronic address: leopisla@hotmail.com. 2. Fundación Hipercolesterolemia Familiar, Madrid, Spain; Nutrition Department, Clínica las Condes, Santiago de Chile, Chile. 3. UCERV-UCAMI, Hospital Virgen del Rocío, Sevilla, Spain. 4. Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain. 5. Lipids Clinic, Department of Endocrinology, Hospital Clinic, (IDIBAPS) Institut d'Investigacions Biomèdiques August Pi i Sunyer University of Barcelona, Barcelona, Spain. 6. Department of Internal Medicine, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain. 7. Lipids and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain. 8. Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain. 9. Department of Epidemiology, Madrid Health Authority, Madrid, Spain. 10. Cardiology Department, Hospital del Tajo, Aranjuez, Universidad Alfonso X el Sabio, Madrid, Spain. 11. Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain. 12. Radiology Department, Fundación Jiménez Díaz, Madrid, Spain. 13. Internal Medicine Department, Fundación Jiménez Díaz, Madrid, Spain. 14. Endocrinology Departmnent, Hospital Universitario de Lugo, Lugo, Spain. 15. Thorax Radiology Department, Hospital Virgen del Rocío, Sevilla, Spain. 16. Cardiothoracic Radiology Department, CDIC, Hospital Clínic de Barcelona, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 17. Radiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 18. UGC de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, Spain. 19. Instituto Catalán Ciencias Cardiovasculares, IIB-Sant Pau, Barcelona, Spain. 20. Fundación Hipercolesterolemia Familiar, Madrid, Spain. Electronic address: pmata@colesterolfamiliar.org.
Abstract
BACKGROUND: Familial hypercholesterolemia (FH) confers an increased risk of premature atherosclerotic disease. Coronary computed tomographic angiography (CTA) can assess preclinical coronary atherosclerosis. OBJECTIVES: To describe coronary CTA findings in asymptomatic molecularly defined FH individuals, to identify those factors related to its presence and extension, and to assess the impact of these results in patients' care and estimated risk. METHODS: Four hundred and forty individuals with FH, without clinical cardiovascular disease, were consecutively enrolled and underwent a coronary CTA that was used to analyze coronary atherosclerosis based on coronary calcium score (CCS), sum of stenosis severity, and plaque composition sum (PCS). For FH patients, cardiovascular risk was estimated using the specific SAFEHEART risk equation. Follow-up was performed using a standardized protocol. RESULTS: Mean age was 46.4 years (231 women, 52%). Coronary calcium was present in 55%, mean CCS was 130.9, 46% had a plaque with lumen involvement, and mean PCS was 1.1. During follow-up, there were 17 (4%) nonfatal events and 2 (1%) fatal events. CCS was independently associated to the estimated risk and low-density lipoprotein-cholesterol life-years, sum of stenosis severity to the estimated risk, and PCS to the estimated risk and low-density lipoprotein-cholesterol life-years. CTA findings induced a positive change in patients' care and in their estimated risk. CONCLUSION: Coronary artery atherosclerosis is highly prevalent in asymptomatic patients with FH and it is independently associated to cardiovascular risk. More advanced disease on CTA was associated with subsequent intensification of therapy and reduction of estimated risk. Further longitudinal studies are required to know if these findings might improve the risk stratification in patients with FH.
BACKGROUND:Familial hypercholesterolemia (FH) confers an increased risk of premature atherosclerotic disease. Coronary computed tomographic angiography (CTA) can assess preclinical coronary atherosclerosis. OBJECTIVES: To describe coronary CTA findings in asymptomatic molecularly defined FH individuals, to identify those factors related to its presence and extension, and to assess the impact of these results in patients' care and estimated risk. METHODS: Four hundred and forty individuals with FH, without clinical cardiovascular disease, were consecutively enrolled and underwent a coronary CTA that was used to analyze coronary atherosclerosis based on coronary calcium score (CCS), sum of stenosis severity, and plaque composition sum (PCS). For FHpatients, cardiovascular risk was estimated using the specific SAFEHEART risk equation. Follow-up was performed using a standardized protocol. RESULTS: Mean age was 46.4 years (231 women, 52%). Coronary calcium was present in 55%, mean CCS was 130.9, 46% had a plaque with lumen involvement, and mean PCS was 1.1. During follow-up, there were 17 (4%) nonfatal events and 2 (1%) fatal events. CCS was independently associated to the estimated risk and low-density lipoprotein-cholesterol life-years, sum of stenosis severity to the estimated risk, and PCS to the estimated risk and low-density lipoprotein-cholesterol life-years. CTA findings induced a positive change in patients' care and in their estimated risk. CONCLUSION: Coronary artery atherosclerosis is highly prevalent in asymptomatic patients with FH and it is independently associated to cardiovascular risk. More advanced disease on CTA was associated with subsequent intensification of therapy and reduction of estimated risk. Further longitudinal studies are required to know if these findings might improve the risk stratification in patients with FH.
Authors: Gerald F Watts; Samuel S Gidding; Pedro Mata; Jing Pang; David R Sullivan; Shizuya Yamashita; Frederick J Raal; Raul D Santos; Kausik K Ray Journal: Nat Rev Cardiol Date: 2020-01-23 Impact factor: 32.419
Authors: Miguel Cainzos-Achirica; Renato Quispe; Reed Mszar; Ramzi Dudum; Mahmoud Al Rifai; Raimund Erbel; Andreas Stang; Karl-Heinz Jöckel; Nils Lehmann; Sara Schramm; Börge Schmidt; Peter P Toth; Jamal S Rana; Joao A C Lima; Henrique Doria de Vasconcellos; Donald Lloyd-Jones; Parag H Joshi; Colby Ayers; Amit Khera; Michael J Blaha; Philip Greenland; Khurram Nasir Journal: J Am Heart Assoc Date: 2022-08-09 Impact factor: 6.106
Authors: Gerald F Watts; David R Sullivan; David L Hare; Karam M Kostner; Ari E Horton; Damon A Bell; Tom Brett; Ronald J Trent; Nicola K Poplawski; Andrew C Martin; Shubha Srinivasan; Robert N Justo; Clara K Chow; Jing Pang Journal: Am J Prev Cardiol Date: 2021-02-04