title: Defining patients at extremely high risk for coronary artery disease in heterozygous familial hypercholesterolemia.
abstract: OBJECTIVE
  Heterozygous patients with familial hypercholesterolemia (FH) are known to be associated with a high risk of coronary artery disease (CAD), which is a major determinant of their clinical outcome. The prognosis of heterozygous FH patients substantially varies, being dependent on the level of their CAD risk, and their therapeutic regimen should be individualized. We assessed critical levels of LDL-cholesterol (LDL-C) and Achilles tendon thickness (ATT) to identify heterozygous FH patients at "very high" risk for CAD.
  
  
  METHODS
  One hundred and nine heterozygous FH patients who had no history of CAD and had had their plasma lipid profile and ATT assessed before treatment were followed up until their first CAD event or 31 December 2010. Multivariable logistic regression models were used to analyze the correlation of LDL-C and/or ATT levels with the risk of developing CAD.
  
  
  RESULTS
  During the follow-up period, 21 of the 109 patients had a CAD event, diagnosed by coronary angiogram. Individuals in the highest tertile of LDL-C had a CAD risk 8.29-fold higher than those in the lowest tertile. Individuals in the highest tertile of the ATT group had a 7.82-fold higher CAD risk than those in the lowest tertile. Those who had either LDL-C ≥ 260 mg/dL or ATT ≥ 14.5 had a 23.94-fold higher CAD risk than those with LDL-C < 260 mg/dL and ATT <14.5 mm.
  
  
  CONCLUSIONS
  In heterozygous FH patients, LDL-C 260 mg/dL or higher and/or ATT 14.5 mm or thicker are useful markers for extracting patients at "very high" risk for CAD.
authors.affiliation: Division of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Sugisawa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Hisashi
authors.initials: H
authors.lastname: Makino
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kishimoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Mariko
authors.initials: M
authors.lastname: Harada-Shiba
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000235:genetics*; D005260:Female; D006579:Heterozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000235:genetics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors