Pseudoxanthoma elasticum and familial hypercholesterolemia: a deleterious combination of cardiovascular risk factors.
OBJECTIVE
Pseudoxanthoma Elasticum (PXE), an autosomal recessive disease due to mutations in ABCC6 gene, is characterised by fragmentation of elastic fibres with involvement of the cardiovascular system. We investigated a 60-year-old female with angina pectoris found to have PXE, associated with elevated plasma LDL-C suspected to be due to autosomal-co-dominant hypercholesterolemia.


METHODS
ABCC6, LDLR, PCSK9 and exon 26 of APOB genes were re-sequenced. Cardiovascular involvement was assessed by coronary angiography, single-photon emission computed tomography (SPECT) and ultrasound examination.


CONCLUSIONS
The patient was a compound heterozygous for two ABCC6 mutations (p.S317R and p.R1141X) and heterozygous for a novel LDLR mutation (p.R574H). She had severe coronary stenosis and calcification of the arteries of the lower limbs. Treatment with ezetimibe/simvastatin 10/60mg/day, maintained over a 4.5-year period, reduced of LDL-C and the myocardial ischemic area. In PXE patients LDL-lowering treatment might contribute to delay macrovascular complications.
Pisciotta
Livia
L
Department of Internal Medicine, University of Genoa, I-16132 Genoa, Italy.
Tarugi
Patrizia
P
Borrini
Claudia
C
Bellocchio
Antonella
A
Fresa
Raffaele
R
Guerra
Deanna
D
Quaglino
Daniela
D
Ronchetti
Ivonne
I
Calandra
Sebastiano
S
Bertolini
Stefano
S
D000293:Adolescent; D000328:Adult; D002648:Child; D003324:Coronary Artery Disease / Q000209:etiology*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D008875:Middle Aged; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000235:genetics; D020125:Mutation, Missense; D010375:Pedigree; D011561:Pseudoxanthoma Elasticum / Q000150:complications*; D012308:Risk Management
D027425:ATP-Binding Cassette, Sub-Family C Proteins; C102029:ABCC6 protein, human