Carotid artery plaques and intima medial thickness in familial hypercholesteraemic patients on long-term statin therapy: A case control study

Atherosclerosis. 2017 Jan;256:62-66. doi: 10.1016/j.atherosclerosis.2016.12.005. Epub 2016 Dec 2.

Abstract

Background and aims: Statins reduce subclinical atherosclerosis and premature atherosclerotic cardiovascular disease (ASCVD) in patients with familial hypercholesterolemia (FH). However, some FH patients still develop ASCVD despite statin therapy. We compared subclinical atherosclerosis assessed by carotid plaque presence and intima media thickness (C-IMT), in long-term statin-treated FH patients and healthy controls. Furthermore, we analysed whether carotid ultrasonography findings associated with subclinical coronary atherosclerosis.

Methods: We assessed the presence of carotid plaques and C-IMT in 221 asymptomatic heterozygous FH patients (48% men; 46 ± 15 years) on long-term (10.0 ± 7.8 years) statin treatment and 103 controls (32% men, 47 ± 16 years).

Results: The frequency of carotid plaques and C-IMT did not differ significantly between the FH patients and controls (69 (31%) versus 24 (23%), p = 0.1 and 0.58 ± 0.13 versus 0.58 ± 0.12 mm, p = 0.9, respectively). In a subgroup of 49 FH patients who underwent cardiac computed tomography, coronary artery calcification correlated with carotid plaque presence (R = 0.47; p = 0.001), but not with C-IMT (R = 0.20; p = 0.2).

Conclusions: Carotid plaques and C-IMT did not differ between long-term statin-treated heterozygous FH patients and healthy controls. This shows that long-term statin treatment in these FH patients reduces carotid atherosclerosis to a degree of a healthy population. These findings strongly suggests that sonography of the carotid arteries during follow-up of statin-treated FH patients has limited value.

Keywords: Carotid intima media thickness; Carotid plaque presence; Familial hypercholesterolemia; Residual risk.

MeSH terms

  • Adult
  • Asymptomatic Diseases
  • Carotid Arteries / diagnostic imaging*
  • Carotid Arteries / pathology
  • Carotid Artery Diseases / diagnostic imaging*
  • Carotid Artery Diseases / genetics
  • Carotid Artery Diseases / pathology
  • Carotid Intima-Media Thickness*
  • Case-Control Studies
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / genetics
  • Female
  • Genetic Predisposition to Disease
  • Heterozygote
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hyperlipoproteinemia Type II / complications
  • Hyperlipoproteinemia Type II / diagnosis
  • Hyperlipoproteinemia Type II / drug therapy*
  • Hyperlipoproteinemia Type II / genetics
  • Male
  • Middle Aged
  • Phenotype
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / genetics

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors