Masatsune Ogura1, Mariko Harada-Shiba1, Daisaku Masuda2,3, Hidenori Arai4, Hideaki Bujo5, Shun Ishibashi6, Hiroyuki Daida7, Nobuhiko Koga8, Shinichi Oikawa9, Shizuya Yamashita2,10,3. 1. Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute. 2. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine. 3. Present address: Department of Cardiology, Rinku General Medical Center. 4. The National Center for Geriatrics and Gerontology. 5. Department of Clinical Laboratory and Experimental Research Medicine, Toho University, Sakura Medical Center. 6. Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University. 7. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine. 8. Shin Koga Hospital, Kurume City. 9. Diabetes and Lifestyle Disease Center, Fukujyuji Hospital, Japan Anti-Tuberculosis Association (JATA). 10. Department of Community Medicine, Osaka University Graduate School of Medicine.
Abstract
AIMS: Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol levels, xanthomas including Achilles tendon thickening, and premature coronary artery disease (CAD). Carotid intima-media thickness (IMT) is a well-established surrogate marker for CAD in FH and Achilles tendon thickening is a specific physical finding in patients with FH. The objective of the present study was to identify factors associated with carotid IMT and Achilles tendon thickness in FH heterozygotes on lipid-lowering therapy. This study also aimed to examine the follow-up changes in carotid IMT and Achilles tendon thickness among them in the current real-world FH practice. METHODS: The current study is a subanalysis of the Familial Hypercholesterolemia Expert Forum (FAME) Study. The severity of carotid atherosclerosis was assessed with the maximal and mean IMT using ultrasonography, and Achilles tendon thickness was measured using X-rays. The present study used 571 patients under medical treatment for heterozygous FH who had baseline measurements for maximal IMT (n=511), mean IMT (n=459), or Achilles tendon thickness (n=486). The IMT was measured annually, and Achilles tendon thickness was evaluated every two years. RESULTS: Higher LDL cholesterol (LDL-C) level and lower HDL cholesterol (HDL-C) level were associated with greater maximal and mean IMT as well as greater Achilles tendon thickness. Achilles tendon thickness tended to be greater in patients who had a smoking history than in never-smokers. Maximal IMT and Achilles tendon thickness were significantly greater in patients with CAD than in those without. Additionally, lower HDL-C level and hypertension were associated with higher values of maximal and mean IMT, suggesting the importance of comprehensive risk management including reduced HDL-C and blood pressure control in FH care. In longitudinal observations, percentage changes in maximal IMT and mean IMT gradually increased during the observation period. In contrast, percentage changes in Achilles tendon thickness became progressively thinner throughout the observation period. CONCLUSIONS: We found a positive association between LDL-C levels and severity of carotid atherosclerosis in heterozygous FH patients on treatment. This observation suggests the insufficiency of lipid-lowering therapy and the presence of therapeutic inertia among clinicians in the real-world FH practice.
AIMS: Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol levels, xanthomas including Achilles tendon thickening, and premature coronary artery disease (CAD). Carotid intima-media thickness (IMT) is a well-established surrogate marker for CAD in FH and Achilles tendon thickening is a specific physical finding in patients with FH. The objective of the present study was to identify factors associated with carotid IMT and Achilles tendon thickness in FH heterozygotes on lipid-lowering therapy. This study also aimed to examine the follow-up changes in carotid IMT and Achilles tendon thickness among them in the current real-world FH practice. METHODS: The current study is a subanalysis of the Familial Hypercholesterolemia Expert Forum (FAME) Study. The severity of carotid atherosclerosis was assessed with the maximal and mean IMT using ultrasonography, and Achilles tendon thickness was measured using X-rays. The present study used 571 patients under medical treatment for heterozygous FH who had baseline measurements for maximal IMT (n=511), mean IMT (n=459), or Achilles tendon thickness (n=486). The IMT was measured annually, and Achilles tendon thickness was evaluated every two years. RESULTS: Higher LDL cholesterol (LDL-C) level and lower HDL cholesterol (HDL-C) level were associated with greater maximal and mean IMT as well as greater Achilles tendon thickness. Achilles tendon thickness tended to be greater in patients who had a smoking history than in never-smokers. Maximal IMT and Achilles tendon thickness were significantly greater in patients with CAD than in those without. Additionally, lower HDL-C level and hypertension were associated with higher values of maximal and mean IMT, suggesting the importance of comprehensive risk management including reduced HDL-C and blood pressure control in FH care. In longitudinal observations, percentage changes in maximal IMT and mean IMT gradually increased during the observation period. In contrast, percentage changes in Achilles tendon thickness became progressively thinner throughout the observation period. CONCLUSIONS: We found a positive association between LDL-C levels and severity of carotid atherosclerosis in heterozygous FH patients on treatment. This observation suggests the insufficiency of lipid-lowering therapy and the presence of therapeutic inertia among clinicians in the real-world FH practice.
Authors: Liam R Brunham; Lubomira Cermakova; Terry Lee; Ida Priecelova; Karine Alloul; Marilyn de Chantal; Gordon A Francis; Jiri Frohlich Journal: Can J Cardiol Date: 2016-09-03 Impact factor: 5.223
Authors: Pernette R W de Sauvage Nolting; Eric de Groot; Aeilko H Zwinderman; Rudolf J A Buirma; Mieke D Trip; John J P Kastelein Journal: Arch Intern Med Date: 2003 Aug 11-25