Bos Sven, Duvekot Martijne H C, Ten Kate Gert-Jan R, Verhoeven Adrie J M, Mulder Monique T, Schinkel Arend F L, Nieman Koen, Watts Gerald F, Sijbrands Eric J G, Roeters van Lennep Jeanine E
Department of Internal Medicine, Division Pharmacology, Vascular and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands.
Department of Cardiology, Thorax Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands.
Atherosclerosis. 2017 Jan;256:62-66. doi: 10.1016/j.atherosclerosis.2016.12.005. Epub 2016 Dec 2.
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.
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).
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).
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.
他汀类药物可降低家族性高胆固醇血症（FH）患者的亚临床动脉粥样硬化及动脉粥样硬化性心血管疾病（ASCVD）的过早发生风险。然而，部分FH患者即便接受了他汀类药物治疗，仍会发生ASCVD。我们比较了长期接受他汀类药物治疗的FH患者与健康对照者通过颈动脉斑块存在情况及内膜中层厚度（C-IMT）评估的亚临床动脉粥样硬化情况。此外，我们分析了颈动脉超声检查结果是否与亚临床冠状动脉粥样硬化相关。
我们评估了221例长期（10.0±7.8年）接受他汀类药物治疗的无症状杂合子FH患者（48%为男性；46±15岁）及103例对照者（32%为男性，47±16岁）的颈动脉斑块存在情况及C-IMT。
FH患者与对照者之间的颈动脉斑块发生率及C-IMT无显著差异（分别为69例（31%）对24例（23%），p = 0.1；以及0.58±0.13对0.58±0.12mm，p = 0.9）。在49例接受心脏计算机断层扫描的FH患者亚组中，冠状动脉钙化与颈动脉斑块存在情况相关（R = 0.47；p = 0.001），但与C-IMT无关（R = 0.20；p = 0.2）。
长期接受他汀类药物治疗的杂合子FH患者与健康对照者之间的颈动脉斑块及C-IMT无差异。这表明这些FH患者长期接受他汀类药物治疗可将颈动脉粥样硬化程度降低至健康人群的水平。这些发现强烈提示，在接受他汀类药物治疗的FH患者随访期间，颈动脉超声检查的价值有限。
