CT Coronary Plaque Burden in Asymptomatic Patients With Familial Hypercholesterolaemia

OBJECTIVES:  To determine the calcium score and coronary plaque burden in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH) compared with a control group of patients with low probability of coronary artery disease, having non-anginal chest pain, using CT.

METHODS: Design, setting and patients 101 asymptomatic patients with FH (mean age 53±7 years; 62 men) and 126 patients with non-anginal chest pain (mean age 56±7 years; 80 men) underwent CT calcium scoring and CT coronary angiography. All patients with FH were treated with statins during a period of 10±8 years before CT. The coronary calcium score and plaque burden were determined and compared between the two patient groups.

RESULTS: The median total calcium score was significantly higher in patients with FH (Agatston score=87, IQR 5–367) than in patients with non-anginal chest pain (Agatston score=7, IQR 0–125; p<0.001). The overall coronary plaque burden was significantly higher in patients with FH (p<0.01). Male patients with FH, whose low-density lipoprotein cholesterol levels were reduced by statins below 3.0 mmol/l, had significantly less coronary calcium (p<0.01) and plaque burden (p=0.02).

CONCLUSIONS: The coronary plaque burden is high in asymptomatic middle-aged patients with FH despite intense statin treatment. Dawuane Smoot Authentic Jersey


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  1. There is an interesting data point shown in Table 2: The plaque composition analysis showed equal number of coronary segments with soft plaque for both cohorts.

    The difference in calcified plaque burden did show significance, though.

    So, what does this say about calcium scoring for screening? It implies (within the limits of the studied cohorts and the number of recruited patients) that a higher calcium score does not imply a higher likelihood of having vulnerable plaque.

    Thoughts anyone?

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