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Cardiovascular medicine
Established and emerging coronary risk factors in patients with heterozygous familial hypercholesterolaemia
  1. H A W Neil1,
  2. V Seagroatt1,
  3. D J Betteridge2,
  4. M P Cooper2,
  5. P N Durrington3,
  6. J P Miller4,
  7. M Seed5,
  8. R P Naoumova7,
  9. G R Thompson6,
  10. R Huxley1,
  11. S E Humphries8
  1. 1Division of Public Health & Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford, UK
  2. 2Department of Medicine, Royal Free and University College London Medical School, London, UK
  3. 3Department of Medicine, University of Manchester, Manchester, UK
  4. 4Wythenshawe Hospital, South Manchester University Hospitals NHS Trust, Manchester, UK
  5. 5Department of Medicine, Imperial College Faculty of Medicine, Charing Cross Hospital, University of London, London, UK
  6. 6Imperial College School of Medicine, University of London, London, UK
  7. 7MRC Clinical Sciences Centre, Imperial College School of Medicine, University of London, London, UK
  8. 8Centre for Cardiovascular Genetics, The Rayne Institute, Royal Free and University College London Medical School, London, UK
  1. Correspondence to:
    Dr H A W Neil
    Division of Public Health & Primary Health Care, Institute of Health Sciences, University of Oxford, Old Road, Headington, Oxford OX3 7LF, UK; andrew.neilwolfson.ox.ac.uk

Abstract

Objectives: To assess the clinical and biochemical factors associated with inter-individual variation in susceptibility to coronary artery disease (CAD) in treated heterozygous familial hypercholesterolaemia.

Design: A cross sectional study was conducted of 410 patients recruited from six lipid clinics in the UK.

Results: CAD was documented in 104 of the 211 men and in 55 of the 199 women with mean ages of onset of 43.1 and 46.5 years, respectively. CAD was significantly more common in men (49% v 28%, p < 0.001) and in patients who had smoked cigarettes versus patients who had never smoked (51% v 28%, p < 0.001). After adjusting for age, sex, and current smoking status, there were no significant differences between patients with or without CAD in lipoprotein(a), homocysteine, fibrinogen, plasminogen activator inhibitor-1, white blood cell count, body mass index, glucose, triglyceride or total cholesterol. However, high density lipoprotein (HDL) cholesterol concentrations were significantly lower in those with CAD (6%, 95% confidence interval (CI) 1% to 11%, p  =  0.03) and this difference was greater in women than men (12% v 2%, p  =  0.041).

Conclusions: These results indicate that emerging coronary risk factors appear not to be associated with CAD in adults with treated familial hypercholesterolaemia, but the strong association with smoking suggests that patients should be identified early in childhood and discouraged from ever starting to smoke.

  • ACE, angiotensin converting enzyme
  • HDL, high density lipoprotein
  • LDL, low density lipoprotein
  • Lp, lipoprotein
  • familial hypercholesterolaemia
  • coronary artery disease
  • coronary risk factors
  • cigarette smoking
  • coronary risk factors

https://doi.org/10.1136/hrt.2003.022764

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