Defining patients at extremely high risk for coronary artery disease in heterozygous familial hypercholesterolemia

Takako Sugisawa, Tomonori Okamura, Hisashi Makino, Makoto Watanabe, Ichiro Kishimoto, Yoshihiro Miyamoto, Noriyuki Iwamoto, Akira Yamamoto, Shinji Yokoyama, Mariko Harada-Shiba

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aim: 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 LDLcholesterol (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.

Original languageEnglish
Pages (from-to)369-375
Number of pages7
JournalJournal of Atherosclerosis and Thrombosis
Volume19
Issue number4
DOIs
Publication statusPublished - 2012

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Hyperlipoproteinemia Type II
Coronary Artery Disease
Achilles Tendon
Tendons
Logistic Models
Logistics
Angiography

Keywords

  • Achilles tendon thickness
  • Coronary artery disease
  • Coronary risk
  • Familial hypercholesterolemia
  • LDL cholesterol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Biochemistry, medical

Cite this

Defining patients at extremely high risk for coronary artery disease in heterozygous familial hypercholesterolemia. / Sugisawa, Takako; Okamura, Tomonori; Makino, Hisashi; Watanabe, Makoto; Kishimoto, Ichiro; Miyamoto, Yoshihiro; Iwamoto, Noriyuki; Yamamoto, Akira; Yokoyama, Shinji; Harada-Shiba, Mariko.

In: Journal of Atherosclerosis and Thrombosis, Vol. 19, No. 4, 2012, p. 369-375.

Research output: Contribution to journalArticle

Sugisawa, T, Okamura, T, Makino, H, Watanabe, M, Kishimoto, I, Miyamoto, Y, Iwamoto, N, Yamamoto, A, Yokoyama, S & Harada-Shiba, M 2012, 'Defining patients at extremely high risk for coronary artery disease in heterozygous familial hypercholesterolemia', Journal of Atherosclerosis and Thrombosis, vol. 19, no. 4, pp. 369-375. https://doi.org/10.5551/jat.11536
Sugisawa, Takako ; Okamura, Tomonori ; Makino, Hisashi ; Watanabe, Makoto ; Kishimoto, Ichiro ; Miyamoto, Yoshihiro ; Iwamoto, Noriyuki ; Yamamoto, Akira ; Yokoyama, Shinji ; Harada-Shiba, Mariko. / Defining patients at extremely high risk for coronary artery disease in heterozygous familial hypercholesterolemia. In: Journal of Atherosclerosis and Thrombosis. 2012 ; Vol. 19, No. 4. pp. 369-375.
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AU - Makino, Hisashi

AU - Watanabe, Makoto

AU - Kishimoto, Ichiro

AU - Miyamoto, Yoshihiro

AU - Iwamoto, Noriyuki

AU - Yamamoto, Akira

AU - Yokoyama, Shinji

AU - Harada-Shiba, Mariko

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N2 - Aim: 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 LDLcholesterol (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.

AB - Aim: 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 LDLcholesterol (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.

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