In heterozygous familial hypercholesterolemia (HeFH) patients without established atherosclerotic cardiovascular disease (ASCVD), coronary atherosclerotic disease burden may be heterogeneous, according to a study published Nov. 11 in JACC: Cardiovascular Imaging, and presented during AHA 2019 in Philadelphia, PA.

Reed Mszar, BS, et al., conducted a pooled estimate of the prevalence of coronary artery calcium (CAC)=0 of existing literature among HeFH patients without established ASCVD. The investigators conducted a literature search and ultimately looked at nine studies representing 1,176 patients.

Results showed that the pooled mean age was 47 years and 53 percent were women. Among 5 of 9 included studies (n=970) that provided information on statin use, results showed that 97 percent of patients were on statins at follow-up. Also in 5 of 9 included studies (n=970) providing on-treatment lipids, results showed the pooled on-treatment LDL-C was 158 mg/dL.

In addition, the investigators found that the mean pooled prevalence of CAC=0 was 45 percent.

The researchers conclude that their study supports the idea that "coronary atherosclerotic disease burden among middle aged HeFH is heterogeneous, with nearly half of these individuals free of clinical ASCVD demonstrating no detectable CAC in spite of significantly elevated LDL-C on maximum therapy in the majority of patients."

Moving forward, they add that the "favorable prognostic value with power of zero (CAC=0) up to 4 years needs to be confirmed in other cohorts and longer-term follow-up."

Clinical Topics: Dyslipidemia, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins

Keywords: AHA19, AHA Annual Scientific Sessions, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hyperlipoproteinemia Type II, Lipids, Coronary Artery Disease, Atherosclerosis, Calcium, Dietary

< Back to Listings