CT coronary plaque burden in asymptomatic patients with familial hypercholesterolaemia

Objective: To determine the calcium score and coronary plaque burden in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH) compared with a control group of patients with low probability of coronary artery disease, having non-anginal chest pain, using CT. Design, setting and patients: 101 asymptomatic patients with FH (mean age 53±7 years; 62 men) and 126 patients with non-anginal chest pain (mean age 56±7 years; 80 men) underwent CT calcium scoring and CT coronary angiography. All patients with FH were treated with statins during a period of 10±8 years before CT. The coronary calcium score and plaque burden were determined and compared between the two patient groups. Results: The median total calcium score was significantly higher in patients with FH (Agatston score=87, IQR 5-367) than in patients with non-anginal chest pain (Agatston score=7, IQR 0-125; p<0.001). The overall coronary plaque burden was significantly higher in patients with FH (p<0.01). Male patients with FH, whose low-density lipoprotein cholesterol levels were reduced by statins below 3.0 mmol/l, had significantly less coronary calcium (p<0.01) and plaque burden (p=0.02). Conclusion: The coronary plaque burden is high in asymptomatic middle-aged patients with FH despite intense statin treatment.