The use of CT coronary calcium score in asymptomatic patients with familial hypercholesterolaemia

Abstract

Background: Familial hypercholesterolaemia (FH) is associated with accelerated atherosclerosis. Diagnosis is based on clinical scores and only 45% of those with a clinical diagnosis have a genetic mutation known to be associated with FH. Coronary artery calcium (CAC) scoring can be used as a surrogate marker for coronary artery disease, but data on its use in FH are scarce. Methods: CAC was performed in 52 asymptomatic patients (16 'probable FH' and 36 'possible FH') classified according to modified Simon Broome criteria, who were attending a secondary care lipid clinic. Demographic and disease characteristics, CAC (Agatston) scores and arterial age were audited. Results: Half the patients had an Agatston score of zero. In those with Agatston scores >0 and age >45 years, the mean arterial age was significantly higher than the chronological age (72 versus 59 years; p=0.0001). Only diabetes and hypertension status were significantly different between those with Agatston scores of 0 and >0 (p=0.045 and p=0.0175 respectively). Arterial age provided information useful for individualised clinical management. Conclusions: Atherosclerosis burden varies widely in FH with diabetes mellitus and hypertension appearing to contribute. We have found the information from CT calcium scoring very useful in identifying those patients with significant atherosclerosis who would need more intensive treatment.