Imaging biomarkers to track subclinical atherosclerosis in heterozygous familial hypercholesterolemia

Abstract

Heterozygous familial hypercholesterolemia (FH) is characterized by high LDL cholesterol levels and premature coronary heart disease onset. Nonetheless, the course of coronary disease events in heterozygous FH subjects is variable. The presence and severity of subclinical atherosclerosis predicts cardiovascular event onset and may help reclassify the risk of clinical events in the general population. In this review, we discuss the possible use of subclinical coronary, carotid and aortic atherosclerosis testing in heterozygous FH subjects for cardiovascular risk stratification and treatment. Many FH subjects present an increased and precocious burden of subclinical vascular disease in comparison to normolipidemic subjects. These subjects may be at higher risk of cardiovascular events and might deserve more aggressive lipid-lowering treatment. Nevertheless, routine screening of imaging biomarkers for FH subjects in clinical practice remains to be determined in prospective trials.