Coronary computed tomographic angiography findings and their therapeutic implications in asymptomatic patients with familial hypercholesterolemia. Lessons from the SAFEHEART study
Por:
de Isla, LP, Alonso, R, Muniz-Grijalvo, O, Diaz-Diaz, JL, Zambon, D, Miramontes, JP, Fuentes, F, de Diego, JJG, Gonzalez-Estrada, A, Mata, N, Saltijeral, A, Barreiro, M, Tomas, M, de Andres, R, Argues, R, Gotarredona, MPS, Herrero, SN, Palazon, RJP, de Caralt, TM, de Centi, LAS, Zhilina, S, Perez, SE, Padro, T, Mata, P
Publicada:
1 ago 2018
Resumen:
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. (C) 2018 National Lipid Association. All rights reserved.
Filiaciones:
de Isla, LP:
Univ Complutense, Hosp Clin San Carlos, Cardiol Dept, IDISSC, Madrid, Spain
Fdn Hipercolesterolemia Familiar, C Gen Alvarez de Castro 14, Madrid, Spain
Alonso, R:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez de Castro 14, Madrid, Spain
Clin Las Condes, Nutr Dept, Santiago, Chile
Muniz-Grijalvo, O:
Hosp Virgen Rocio, UCERV UCAMI, Seville, Spain
Diaz-Diaz, JL:
Hosp Abente & Lago, Dept Internal Med, La Coruna, Spain
Zambon, D:
Univ Barcelona, IDIBAPS Inst Invest Biomed August Pi & Sunyer, Dept Endocrinol, Lipids Clin,Hosp Clin, Barcelona, Spain
Miramontes, JP:
Hosp Univ Salamanca, Dept Internal Med, IBSAL, Salamanca, Spain
Fuentes, F:
Univ Cordoba, IMIBIC Reina Sofia Univ Hosp, Lipids & Atherosclerosis Unit, Cordoba, Spain
de Diego, JJG:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez de Castro 14, Madrid, Spain
Gonzalez-Estrada, A:
Hosp Virgen Rocio, UCERV UCAMI, Seville, Spain
Mata, N:
Fdn Hipercolesterolemia Familiar, C Gen Alvarez de Castro 14, Madrid, Spain
Madrid Hlth Author, Dept Epidemiol, Madrid, Spain
Saltijeral, A:
Univ Alfonso X el Sabio, Hosp Tajo, Cardiol Dept, Madrid, Spain
Barreiro, M:
Hosp Univ Salamanca, Cardiol Dept, Salamanca, Spain
Tomas, M:
Fdn Jimenez Diaz, Radiol Dept, Madrid, Spain
de Andres, R:
Fdn Jimenez Diaz, Internal Med Dept, Madrid, Spain
Argues, R:
Hosp Univ Lugo, Endocrinol Dept, Lugo, Spain
Gotarredona, MPS:
Hosp Virgen Rocio, Thorax Radiol Dept, Seville, Spain
Herrero, SN:
Hosp Virgen Rocio, Thorax Radiol Dept, Seville, Spain
Palazon, RJP:
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin Barcelona, Cardiothorac Radiol Dept,CDIC, Barcelona, Spain
de Caralt, TM:
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin Barcelona, Cardiothorac Radiol Dept,CDIC, Barcelona, Spain
de Centi, LAS:
Complejo Hosp Univ A Coruna, Radiol Dept, La Coruna, Spain
Zhilina, S:
Hosp Univ Salamanca, Dept Internal Med, IBSAL, Salamanca, Spain
Perez, SE:
Hosp Univ Reina Sofia, UGC Radiodiagnost, Cordoba, Spain
Padro, T:
IIB St Pau, Inst Catalan Ciencias Cardiovasc, Barcelona, Spain
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