Silent ischaemia in familial hypercholesterolemia

The Agenda for Familial Hypercholesterolemia

“…Studies that include a small number of subjects performed in the prestatin era using either cardiac scintigraphy or exercise stress test showed the presence of silent ischemia in ≈20% of asymptomatic heterozygous FH men and male teenagers (mean age, 16 years). 76,77 In these studies, the presence of ischemia was not associated with LDL-C levels, smoking, or age. A positive exercise stress test was also found in 20% of 194 heterozygous FH men and women without previous manifestation of cardiovascular Table 3.…”

Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation

“…Patients who are obese and/or insulin resistant should be counselled on weight loss and aerobic exercise regimens [8,[100][101][102]. Prior to initiation of an exercise regimen, some patients will warrant stress testing (electro-or echocardiography, nuclear perfusion scanning) to assess myocardial functional capacity and the possibility of silent ischaemia [11,45,106].…”

Exercise testing in asymptomatic patients with heterozygous familial hypercholesterolaemia

“…The mean age of our patients and the presence of at least one powerful risk factor for CAD increase the accuracy of the method in this particular group of patients. In addition, Descamps et al suggested that because a great proportion of FH men seem to suffer from myocardial ischaemia (either asymptomatic or symptomatic) and because even the silent form has been found to be associated with severe coronary stenosis, ET should be systematically performed in asymptomatic FH men after the age of 25 [24].…”