Abstract
Calcified and Noncalcified Coronary Plaques and Atherosclerotic Cardiovascular Events in Patients With Severe Hypercholesterolemia—Moving Forward With Risk Stratification and Therapy
Highlights
Overall, the absence of plaques was associated with a low atherosclerotic cardiovascular disease (ASCVD) event rate and mortality independently of the LDL-C strata; on the other hand, plaque presence and most importantly the higher CAC score was associated with a greater risk.[1]
What are the clinical implications of the present study? First, it extends the apparent “safety bubble” when CAC or plaque is absent to people with severe hypercholesterolemia and possible symptoms of coronary artery disease
The study by Mortensen et al[1] had a 4-fold greater number of individuals with severe hypercholesterolemia than that of Sandesara et al[5]; the median follow-up was 3-fold shorter, and there was no formal diagnosis of familial hypercholesterolemia compared with the studies of Miname et al[3] and Gallo et al.[4]
Summary
The absence of plaques was associated with a low ASCVD event rate and mortality independently of the LDL-C strata; on the other hand, plaque presence and most importantly the higher CAC score was associated with a greater risk.[1]. Miname et al[3] and more recently Gallo et al[4] have encountered a very low risk of ASCVD events in asymptomatic individuals with proven genetic diagnosis of familial hypercholesterolemia and CAC scores of 0, most of them were using
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