Triple Assessments of Atherosclerosis in Patients With Heterozygous Familial Hypercholesterolemia.

Background: Data on the appropriate timing and impact of atherosclerosis assessment in patients with heterozygous familial hypercholesterolemia (HeFH) are limited.

Objectives: The authors aimed to determine when atherosclerotic changes occur and the utility of triple assessments of carotid plaque, coronary plaque, and coronary artery calcium (CAC) in patients with HeFH.

Methods: Data from patients with HeFH in the primary prevention setting admitted to Kanazawa University Hospital between 2000 and 2020 who underwent triple atherosclerosis assessment and were followed up were retrospectively reviewed (n = 622, male = 306, mean age = 54 ± 13 years). Risk factors for coronary heart disease events were determined using the Cox proportional hazard model. Carotid plaque, coronary plaque, and CAC scores were plotted against age.

Results: We found that the age was independently associated with coronary heart disease events. Regression equations of carotid plaque, coronary plaque, and CAC scores against age were Y = 0.12X - 2.07 (β coefficient = 0.12 [95% CI: 0.09-0.15]; r² = 0.12), Y = 0.36X - 9.30 (β coefficient = 0.36 [95% CI: 0.26-0.46]; r² = 0.14), and Y = 2.48X - 77.23 (β coefficient = 0.07 [95% CI: 0.04-0.10]; r² = 0.23) in men and Y = 0.12X - 3.60 (β coefficient = 0.12 [95% CI: 0.08-0.16]; r² = 0.18), Y = 0.33X - 11.75 (β coefficient = 0.33 [95% CI: 0.29-0.37]; r² = 0.17), and Y = 2.23X - 89.47 (β coefficient = 0.09 [95% CI: 0.06-0.12]; r² = 0.34) in women, respectively. Significant differences of cardiovascular events were observed among the groups according to atherosclerotic burden.

Conclusions: On average, carotid plaque, coronary plaque, and CAC may develop at ages 17, 26, and 31 years in male patients and 30, 36, and 40 years in female patients with HeFH, respectively, based on regression equations. Furthermore, triple assessments help in risk stratification.