Quantification of coronary artery calcification in patients with FH using EBCT

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Abstract
Background Calcification of the coronary vessel wall is regarded as a marker of advanced coronary atherosclerosis. Methods To test whether patients with heterozygous familial hypercholesterolemia (FH) exhibit excessive calcification of the coronary vessel wall, we quantified coronary artery calcium in LDL‐apheresis treated FH‐patients with known severe coronary artery disease (CAD) (n = 10), in patients with moderate hypercholesterolemia and known severe CAD (n = 10), and in asymptomatic controls (n = 10) using electronic beam CT. The total coronary calcium score (Agatston‐Score), the number of calcified lesions and the calcified plaque volume were evaluated for this study. Results CAD‐patients with FH, although on average 10 years younger, had a significantly higher total coronary calcium score (702/2018/2890), number of lesions (34/43/49) and calcified plaque volume (700/1818/2313) compared to patients with CAD only (480/641/1362, 10/16·5/22, 480/588/1209, respectively) and controls (10/47/137, 2/4/10, 15/50/144, respectively). Furthermore, we observed a significant correlation (r = 0·93; P < 0·01) between LDL‐cholesterol levels (pretreatment levels of the CAD‐FH group) and the total coronary calcium score in all three groups. Our results demonstrate that coronary artery calcification is more extensive in CAD‐patients with FH than in CAD‐patients with moderate hypercholesterolemia. In addition, we provide evidence that the amount of calcium in the coronary vessel wall in FH patients result from a long lasting history of elevated LDL‐Cholesterol levels. Conclusion These findings emphasize the significance of LDL‐cholesterol as a risk factor for atherosclerosis and underline the importance of early diagnosis of CAD and early cholesterol lowering therapy in FH patients.

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