Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study

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• dc.contributor.author Nasir, Khurram
• dc.contributor.author Mszar, Reed
• dc.contributor.author Cainzos-Achirica, Miguel
• dc.contributor.author Grandhi, Gowtham R.
• dc.contributor.author Tromp, Tycho R.
• dc.contributor.author Alonso, Rodrigo
• dc.contributor.author Bittencourt, Márcio S.
• dc.contributor.author Bruckert, Eric
• dc.contributor.author Díaz Díaz, José Luis
• dc.contributor.author Gallo, Antonio
• dc.contributor.author Hovingh, G. Kees
• dc.contributor.author Miname, Marcio H.
• dc.contributor.author Muñiz-Grijalvo, Ovidio
• dc.contributor.author Pang, Jing
• dc.contributor.author Pérez de Isla, Leopoldo
• dc.contributor.author Sijbrands, Eric J. G.
• dc.contributor.author Watts, Gerald F.
• dc.contributor.author Mata, Pedro
• dc.contributor.author Santos, Raul D.
• dc.date.accessioned 2024-09-27T06:20:55Z
• dc.date.available 2024-09-27T06:20:55Z
• dc.date.issued 2023
• dc.description.abstract Objectives: Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods: We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1-100, 101-400, >400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results: Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1-100, 160 (16%) had CAC 101-400, and 99 (10%) had CAC >400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1-100 (8% [n = 15] vs 18% [n = 26]), CAC 101-400 (32% [n = 22] vs 40% [n = 36]), and CAC >400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50-59 years were less likely to have obstructive CAD in CAC >400 (55% [n = 6] vs 70% [n = 19]). Conclusion: In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.
• dc.format.mimetype application/pdf
• dc.identifier.citation Nasir K, Mszar R, Cainzos-Achirica M, Grandhi GR, Tromp TR, Alonso R, et al. Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study. Am J Prev Cardiol. 2023 Nov 23;17:100611. DOI: 10.1016/j.ajpc.2023.100611
• dc.identifier.doi http://dx.doi.org/10.1016/j.ajpc.2023.100611
• dc.identifier.issn 2666-6677
• dc.identifier.uri http://hdl.handle.net/10230/61254
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Am J Prev Cardiol. 2023 Nov 23;17:100611
• dc.rights © 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Atherosclerotic cardiovascular disease
• dc.subject.keyword Coronary artery calcium
• dc.subject.keyword Familial hypercholesterolemia
• dc.subject.keyword Low-density lipoprotein cholesterol
• dc.subject.keyword Plaque burden
• dc.title Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion