Sidhu P S, Naoumova R P, Maher V M, MacSweeney J E, Neuwirth C K, Hollyer J S, Thompson G R
Department of Diagnostic Radiology, Hammersmith Hospital, London, UK.
J Cardiovasc Risk. 1996 Feb;3(1):61-7.
Increased frequency of coronary heart disease in familial hypercholesterolaemia is well documented but the association with carotid atherosclerosis is less well established. The ultrasound appearances of the carotid arteries in familial hypercholesterolaemia patients without symptomatic cerebrovascular disease were therefore investigated.
59 patients (34 men, 25 women; mean age 46.6 (+/-12.1 years) were prospectively studied using ultrasound examination of the extracranial carotid vessels. Intimal-medial thickness was measured 1 cm proximal to the carotid bulb and morphology of plaque was classified as heterogeneous or homogeneous according to echogenicity.
44 (75.0%) of the patients had carotid artery disease. On stepwise logistic regression, significant predictors of the presence of carotid artery disease were age (P = 0.014), serum triglycerides at time of examination (P = 0.013), coexistent coronary heart disease (P = 0.03) and the cholesterol-years score (CYS) (P = 0.015). Heterogeneous carotid plaque was associated with a higher plasma level of Lp(a) (P = 0.035), TG (P = 0.024), CYS (P = 0.0003) and the presence of CHD (P = 0.001). Matched pairs (n = 22) of patients, where the only variable was Lp(a), showed a marked increase in heterogeneous plaque frequency in those with high Lp(a) levels (P < 0.03).
Asymptomatic carotid artery disease occurs in a high proportion of familial hypercholesterolaemia patients. The presence of heterogeneous carotid plaque is significantly associated with the presence of coronary heart disease, the calculated cholesterol-years score, hypertriglyceridaemia and raised levels of Lp(a).
家族性高胆固醇血症中冠心病发病率增加已有充分文献记载，但与颈动脉粥样硬化的关联尚不太明确。因此，对无症状脑血管疾病的家族性高胆固醇血症患者的颈动脉超声表现进行了研究。
前瞻性研究了59例患者（34例男性，25例女性；平均年龄46.6（±12.1岁）），采用超声检查颅外颈动脉血管。在颈动脉球近端1 cm处测量内膜中层厚度，根据回声性将斑块形态分为不均匀或均匀。
44例（75.0%）患者患有颈动脉疾病。逐步逻辑回归分析显示，颈动脉疾病存在的显著预测因素为年龄（P = 0.014）、检查时的血清甘油三酯（P = 0.013）、并存的冠心病（P = 0.03）和胆固醇年评分（CYS）（P = 0.015）。不均匀颈动脉斑块与较高的血浆Lp(a)水平（P = 0.035）、甘油三酯（P = 0.024）、CYS（P = 0.0003）以及冠心病的存在（P = 0.001）相关。仅以Lp(a)为唯一变量的配对患者（n = 22）显示，Lp(a)水平高的患者中不均匀斑块频率显著增加（P < 0.03）。
无症状颈动脉疾病在家族性高胆固醇血症患者中占很高比例。不均匀颈动脉斑块的存在与冠心病的存在、计算出的胆固醇年评分、高甘油三酯血症和Lp(a)水平升高显著相关。
