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CT coronary plaque burden in asymptomatic patients with familial hypercholesterolaemia
  1. Lisan A Neefjes1,2,3,
  2. Gert-Jan R ten Kate1,2,3,
  3. Alexia Rossi1,3,
  4. Annette J Galema-Boers4,
  5. Janneke G Langendonk4,
  6. Annick C Weustink1,3,
  7. Adriaan Moelker1,
  8. Koen Nieman1,3,
  9. Nico R Mollet1,3,
  10. Gabriel P Krestin1,
  11. Eric J Sijbrands4,
  12. Pim J de Feyter1,3
  1. 1Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  3. 3Department of Cardiology, Thorax Center Rotterdam, The Netherlands
  4. 4Department of Internal Medicine, Erasmus Medical Center Rotterdam, The Netherlands
  1. Correspondence to Lisan A Neefjes, Erasmus Medical Center Rotterdam, Department of Radiology and Cardiology, Room Ca 220, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; l.neefjes{at}


Objective To determine the calcium score and coronary plaque burden in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH) compared with a control group of patients with low probability of coronary artery disease, having non-anginal chest pain, using CT.

Design, setting and patients 101 asymptomatic patients with FH (mean age 53±7 years; 62 men) and 126 patients with non-anginal chest pain (mean age 56±7 years; 80 men) underwent CT calcium scoring and CT coronary angiography. All patients with FH were treated with statins during a period of 10±8 years before CT. The coronary calcium score and plaque burden were determined and compared between the two patient groups.

Results The median total calcium score was significantly higher in patients with FH (Agatston score=87, IQR 5–367) than in patients with non-anginal chest pain (Agatston score=7, IQR 0–125; p<0.001). The overall coronary plaque burden was significantly higher in patients with FH (p<0.01). Male patients with FH, whose low-density lipoprotein cholesterol levels were reduced by statins below 3.0 mmol/l, had significantly less coronary calcium (p<0.01) and plaque burden (p=0.02).

Conclusion The coronary plaque burden is high in asymptomatic middle-aged patients with FH despite intense statin treatment.

  • CT
  • coronary plaque burden
  • atherosclerosis
  • familial hypercholesterolaemia
  • CT scanning
  • lipids, coronary artery disease (CAD)

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  • EJS and PJF contributed equally to this article.

  • Funding This study was supported by a grant from the Dutch Heart Foundation, The Hague, the Netherlands and the Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethical review board of the Erasmus Medical Center Rotterdam.

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