Evaluation of coronary risk factors in patients with heterozygous familial hypercholesterolemia

Paul N. Hopkins, Susan Stephenson, Lily L. Wu, Ward A. Riley, Yuanpei Xin, Steven Hunt

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Age at onset of clinically manifested coronary artery disease (CAD) varies widely among patients with familial hypercholesterolemia (FH). A number of factors in addition to high low-density lipoprotein cholesterol (LDL) have been suggested as predictors of risk among patients with FH, but a comprehensive examination of their utility is lacking. We therefore measured plasma lipids, carotid intima-medial thickness, and a variety of coronary risk factors in 262 patients with FH ≥30 years old (68 of whom had premature CAD). Age (p < 0.0001) and gender were the most important determinants of premature CAD risk, with men having 5.64 times the risk of women (p < 0.0001). In addition, cigarette smoking (odds ratio [OR] 2.71, p = 0.026), smaller LDL as determined by the LDL cholesterol/LDL apolipoprotein B ratio (OR 2.60, p = 0.014), and white blood cell count (p = 0.014) were also statistically significant risk factors. Lipoprotein(a) and the presence of xanthoma were associated with risk only in very early coronary cases. After correction for age, carotid intima-media thickness was not associated with CAD risk. Insulin, fibrinogen, homocysteine, plasma C-reactive protein, and the angiotensin-converting enzyme insertion/deletion polymorphism were unrelated to risk in this cohort. These results provide little justification for extensive investigation of risk factors among patients with FH, at least for the risk factors examined here. Rather, the inherent high LDL cholesterol of these patients should be the focus of preventive efforts. The novel finding of increased risk with smaller LDL may prove useful but needs further confirmation.

Original languageEnglish
Pages (from-to)547-553
Number of pages7
JournalAmerican Journal of Cardiology
Volume87
Issue number5
DOIs
Publication statusPublished - 1 Mar 2001
Externally publishedYes

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Hyperlipoproteinemia Type II
LDL Cholesterol
Coronary Artery Disease
HDL Cholesterol
Odds Ratio
Cholesterol
Xanthomatosis
Carotid Intima-Media Thickness
Lipoprotein(a)
Apolipoproteins B
Homocysteine
Peptidyl-Dipeptidase A
Leukocyte Count
Age of Onset
C-Reactive Protein
Fibrinogen
Blood Proteins
Smoking
Insulin
Lipids

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Evaluation of coronary risk factors in patients with heterozygous familial hypercholesterolemia. / Hopkins, Paul N.; Stephenson, Susan; Wu, Lily L.; Riley, Ward A.; Xin, Yuanpei; Hunt, Steven.

In: American Journal of Cardiology, Vol. 87, No. 5, 01.03.2001, p. 547-553.

Research output: Contribution to journalArticle

Hopkins, Paul N. ; Stephenson, Susan ; Wu, Lily L. ; Riley, Ward A. ; Xin, Yuanpei ; Hunt, Steven. / Evaluation of coronary risk factors in patients with heterozygous familial hypercholesterolemia. In: American Journal of Cardiology. 2001 ; Vol. 87, No. 5. pp. 547-553.
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