Improved coronary risk assessment with electron beam computed tomography in an asymptomatic female with familial hypercholesterolemia.
An asymptomatic 36-year-old woman had high cholesterol levels due to heterozygous familial hypercholesterolemia (FHC) and a family history of coronary artery disease (CAD) but no other risk factors. Exercise testing showed no signs of ischemia. Conventional drug therapy did not lower lipid levels adequately. However, low-density lipoprotein (LDL) apheresis, which effectively reduces cholesterol levels in patients with heterozygous FHC, was not indicated, according to current guidelines. Electron beam computed tomography demonstrated exceptionally high amounts of coronary calcium for the patient's age and sex. A subsequent coronary angiogram revealed advanced CAD, which justified the initiation of LDL apheresis to reduce her cholesterol levels. In patients with heterozygous FHC refractory to conventional lipid-lowering therapy, the presence of coronary calcium in the highest percentiles for age and sex (i.e., > 75th percentile) may warrant aggressive clinical management to improve prognosis, even if no symptoms or signs of ischemia are present.
Möhlenkamp
S
S
Department of Physiology and Biophysics, Mayo Clinic Rochester, MN 55905, USA.
Park
J W
JW
Grönemeyer
D
D
Schwartz
R S
RS
Erbel
R
R
D000328:Adult; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications*; D012306:Risk; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed