The Assessment of Carotid Atherosclerotic Plaque among Young Patients with Familial Hypercholesterolemia

Abstract

Objective Few data exist regarding when atherosclerotic changes occur among patients with familial hypercholesterolemia (FH). Carotid ultrasonography is a non-invasive method of evaluating this issue. The present study (1) compared the clinical utilities of carotid intima-media thickness (cIMT) and carotid plaque score (cPS) and (2) estimated the onset and progression of carotid atherosclerosis among patients with heterozygous FH (HeFH). Methods We retrospectively analyzed 511 patients under 30 years old who underwent carotid ultrasonography at our hospital from 2006 to 2019. We classified them into the HeFH group (n=78, 21.4±5.9 years old) and non-FH group (n=433, 23.4±6.0 years old) based on the clinical diagnosis and compared their cIMT and cPS values. In addition, we estimated the onset and progression of carotid atherosclerosis among young HeFH patients. Results There was no significant difference in the cIMT between the HeFH and non-FH groups (0.44 mm vs. 0.42 mm, p=0.25). In contrast, the cPS was significantly higher in the HeFH group than in the non-FH group (1.11 vs. 0.26, p=0.002). The regression equation for cPS of HeFH group was Y=-2.05+0.15X (r=0.37, p<0.001). Conclusion An assessment based on the cPS rather than the cIMT appears to be better to capture the progress of carotid atherosclerosis among young HeFH patients. Carotid atherosclerosis may start to develop at 14 years old in patients with HeFH.

Early atherosclerosis in familial hypercholesterolemia patients: significance of vascular markers for risk stratification

“…Another commonly used test for the assessment of cardiovascular risk is carotid ultrasound and the assessment of atherosclerotic plaque formation in the carotid artery. Carotid plaques are also strongly positively associated with cardiovascular risk (5,17). In this study, carotid plaques were more common among males and hypertensive patients.…”

“…Furthermore, cardiovascular disease is 3.5 times more prevalent in the FH population than in the general population (4). Even more concerning, studies have shown that atherosclerotic vascular changes may be present in FH patients even in childhood (5).…”

Early Atherosclerosis in Familial Hypercholesterolemia Patients: Significance of Vascular Markers for Risk Stratification

“…Another commonly used test for the assessment of cardiovascular risk is carotid ultrasound and the assessment of atherosclerotic plaque formation in the carotid artery. Carotid plaques are also strongly positively associated with cardiovascular risk [ 5 , 18 ]. In this study, carotid plaques were more common among males and hypertensive patients.…”

“…Furthermore, cardiovascular disease is 3.5 times more prevalent in the FH population than in the general population [ 4 ]. Even more concerning, studies have shown that atherosclerotic vascular changes may be present in FH patients even in childhood [ 5 ]. Therefore, cardiovascular risk stratification should be one of the most important steps in the evaluation of FH patients, and vascular markers may provide a unique opportunity for the noninvasive evaluation of atherosclerosis in each patient.…”