Mottola Giorgio, Welty Francine K, Mojibian Hamid R, Faridi Kamil F
Department of Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States.
Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
Front Cardiovasc Med. 2023 Sep 19;10:1272944. doi: 10.3389/fcvm.2023.1272944. eCollection 2023.
ApoB-containing lipoproteins including low-density lipoprotein cholesterol (LDL-C) are necessary for the development of atherosclerosis, and lifelong exposure to low serum levels of LDL-C have been associated with a substantial reduction of cardiovascular risk. Although plaque regression has been observed in patients with serum LDL-C less than 70-80 mg/dl on lipid-lowering therapy, an LDL-C level under which atherosclerosis cannot develop has not been established.
In this case we describe a 60-year-old man with well-controlled diabetes mellitus and hypertension who presented to the hospital after an acute stroke likely due to an atrial myxoma discovered on imaging. A coronary computed tomography angiography scan performed in preparation for the planned surgical myxoma resection revealed an anomalous origin of the right coronary artery as well as evidence of nonobstructive coronary atherosclerosis in the right coronary and non-anomalous left coronary system. Despite not having ever been on any lipid-lowering therapy, this patient was found to have low LDL-C levels (<40 mg/dl) during this admission and on routine laboratory data collected over the prior 16 years. His family history strongly suggested heterozygous familial hypobetalipoproteinemia as a possible diagnosis.
This case illustrates that even long-standing, very low levels of LDL-C may be insufficient to completely prevent atherosclerosis and emphasizes the importance of primordial prevention of all cardiovascular risk factors.
包括低密度脂蛋白胆固醇（LDL-C）在内的载脂蛋白B的脂蛋白对于动脉粥样硬化的发展是必要的，并且终生暴露于低血清水平的LDL-C与心血管风险的显著降低相关。尽管在接受降脂治疗的血清LDL-C低于70-80mg/dl的患者中观察到斑块消退，但尚未确定一个LDL-C水平，低于该水平动脉粥样硬化就不会发生。
在本病例中，我们描述了一名60岁男性，患有控制良好的糖尿病和高血压，因影像学检查发现心房黏液瘤后发生急性中风而入院。为计划中的黏液瘤手术切除进行的冠状动脉计算机断层扫描血管造影显示右冠状动脉起源异常，以及右冠状动脉和非异常左冠状动脉系统存在非阻塞性冠状动脉粥样硬化的证据。尽管该患者从未接受过任何降脂治疗，但在此次入院期间以及在过去16年收集的常规实验室数据中发现其LDL-C水平较低（<40mg/dl）。他的家族史强烈提示可能诊断为杂合子家族性低β脂蛋白血症。
本病例表明，即使长期处于非常低水平的LDL-C也可能不足以完全预防动脉粥样硬化，并强调了对所有心血管危险因素进行一级预防的重要性。
