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Cyanotic congenital heart disease and atherosclerosis
  1. Julie Bjerre Tarp1,2,
  2. Annette Schophuus Jensen1,
  3. Thomas Engstrøm1,
  4. Niels-Henrik Holstein-Rathlou2,
  5. Lars Søndergaard1
  1. 1 Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2 Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Julie Bjerre Tarp, Department of Cardiology, Rigshospitalet, section 2012, Blegdamsvej 9, Copenhagen 2100, Denmark; julie.bjerre.tarp{at}


Improved treatment options in paediatric cardiology and congenital heart surgery have resulted in an ageing population of patients with cyanotic congenital heart disease (CCHD). The risk of acquired heart disease such as atherosclerosis increases with age.

Previous studies have speculated whether patients with CCHD are protected against atherosclerosis. Results have shown that the coronary arteries of patients with CCHD are free from plaques and stenosis. Decreased carotid intima-media thickness and low total plasma cholesterol may indicate a reduced risk of later development of atherosclerosis. However, the evidence is still sparse and questionable, and a reasonable explanation for the decreased risk of developing atherosclerosis in patients with CCHD is still missing.

This review provides an overview of what is known about the prevalence and potential causes of the reduced risk of atherosclerosis in patients with CCHD.

  • Congenital heart disease
  • Coronary artery disease
  • Statistics and study design
  • Complex congenital heart disease
  • Lipoproteins and hyperlipidemia

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online figure 1 has been updated. The bottom section now includes the box lower cholesterol.