title: Evaluation of subclinical atherosclerosis by computed tomography coronary angiography and its association with risk factors in familial hypercholesterolemia.
abstract: BACKGROUND
  Increasing age and cholesterol levels, male gender, and family history of early coronary heart disease (CHD) are associated with early onset of CHD in familial hypercholesterolemia (FH).
  
  
  OBJECTIVE
  Assess subclinical atherosclerosis by computed tomography coronary angiography (CTCA) and its association with clinical and laboratorial parameters in asymptomatic FH subjects.
  
  
  METHODS
  102 FH subjects (36% male, 45 ± 13 years, LDL-c 280 ± 54 mg/dL) and 35 controls (40% male, 46 ± 12 years, LDL-c 103 ± 18 mg/dL) were submitted to CTCA. Plaques were divided into calcified, mixed and non-calcified; luminal stenosis was characterized as >50% obstruction.
  
  
  RESULTS
  FH had a greater atherosclerotic burden represented by higher number of patients with: plaques (48% vs. 14%, p=0.0005), stenosis (19% vs. 3%, p=0.015), segments with plaques (2.05 ± 2.85 vs.0.43 ± 1.33, p=0.0016) and calcium scores (55 ± 129 vs. 38 ± 140, p=0.0028). After multivariate analysis, determinants of plaque presence were increasing age (OR=2.06, for age change of 10 years, CI95%: 1.38-3.07, p<0.001) and total cholesterol (OR=1.86, for cholesterol change by 1 standard deviation, CI95%: 1.09-3.15, p=0.027). Coronary calcium score was associated with the presence of stenosis (OR=1.54; CI95%: 1.27-1.86, p<0.001, for doubling the calcium score). Male gender was directly associated with the presence of non-calcified plaques (OR: 15.45, CI95% 1.72-138.23, p=0.014) and inversely with calcified plaques (OR=0.21, CI95%: 0.05-0.84, p=0.027). Family history of early CHD was associated with the presence of mixed plaques (OR=4.90, CI95%: 1.32-18.21, p=0.018).
  
  
  CONCLUSIONS
  Patients with FH had an increased burden of coronary atherosclerosis by CTCA. The burden of atherosclerosis and individual plaque subtypes differed with the presence of other associated risk factors, with age and cholesterol being most important. A coronary calcium score of zero ruled out obstructive disease in this higher risk population.
authors.affiliation: Lipid Clinic Heart Institute (InCor), University of São Paulo, Medical School Hospital, São Paulo, Brazil.
authors.forename: Marcio H
authors.initials: MH
authors.lastname: Miname
authors.forename: Mario S
authors.initials: MS
authors.lastname: Ribeiro
authors.forename: José
authors.initials: J
authors.lastname: Parga Filho
authors.forename: Luis F
authors.initials: LF
authors.lastname: Avila
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Bortolotto
authors.forename: Lilton R C
authors.initials: LR
authors.lastname: Martinez
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
mesh_terms: D000328:Adult; D000367:Age Factors; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D008078:Cholesterol, LDL / Q000097:blood*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D008078:Cholesterol, LDL