Secondary Prevention with Lipid Lowering Therapy in Familial Hypercholesterolemia: A Correlation between New Evolution of Stenotic Lesion and Achieved Cholesterol Levels after Revascularization Procedures.

Abstract

Object: T o assess the value of secondary prevention with lipid lowering therapy following either balloon angioplasty (PTCA) or bypass surgery (CABG) in familial hypercholesterolemia patients, the correlation of the new evolution of stenotic lesions and therapeutically achieved cholesterol levels was studied in 50 patients.Methods: All surviving patients were followed angiographically after 5 years, and findings were correlated with the annually determined total serum cholesterol (TC) levels.Results: Newcoronary atherosclerotic plaques were not observed in 18 patients in whomthe TC was controlled to <220 mg/dl but in 19 of32 patients in whomthe TC was >220 mg/dl, a new evolution of stenotic lesions was observed angiographically.Conclusion: The new evolution of stenotic lesions following revascularization in patients with FH can be controlled significantly by lipid lowering therapy to maintain a TC level of <220 mg/dl, and if diet alone can not achieve it, aggressive medication and even LDLapheresis might be justified. (Internal Medicine 38: 330-335, 1999)

Estimated Prevalence of Heterozygous Familial Hypercholesterolemia in Patients With Acute Coronary Syndrome

“…36) Once diagnosed, heterozygous FH patients can readily be treated with cholesterol-lowering medication to attenuate the development of atherosclerosis and prevent the development of CAD. [37][38][39][40][41] Study limitations: This study had several limitations. First, the possibility of underdiagnosing heterozygous FH in patients with ACS cannot be denied because we found a considerable number of patients with ATT of 9 mm or more without diagnosing heterozygous FH.…”

An Uncommon Association of Sever Early Coronary Artery Disease and Aortic Coarctation in Patient with Familial Hypercholesterolemia: A Case Report

“…The management of patients with FH with coronary disease depends on two parts, the first is medical and the second is surgical, as there is no long-term benefit from surgery unless total cholesterol level is strictly controlled, the researches indicate that achieving a total blood cholesterol level of less than 220 mg is of utmost importance to prevent the development of existing coronary disease as well as to prevent the occurrence of new coronary injuries. 4,5 The benefits of using arterial grafts in particular in FH patients have been documented in several studies in terms of long-term survival as well as freedom from coronary revascularization. 6,7 The comparison between the use of the right internal thoracic artery as a second graft (after using the left internal thoracic artery for grafting the anterior descending artery) and the saphenous vein is demonstrated by a meta-analysis of the superiority of the right internal thoracic artery in terms of long-term survival with a higher risk of deep sternal wound infection.…”

Triple Vessel Coronary Artery Bypass Grafting in a 14-year-old Child with Familial Hypercholesterolemia-A Rare Case Report

“…2,3 Aggressive lipid lowering with LDL apheresis and plasmapheresis is extremely important to prevent recurrence, and new lesions occur if total cholesterol remains greater than 220 mg%. 4,5 The use of arterial conduits for coronary problems in infants and children is now well accepted, with excellent long-term patency and growth in children with Kawasaki disease, postarterial switch, and other congenital coronary lesions. 6,7 Differences in adaptation to growth of children have been shown between arterial and venous grafts, with thoracic artery growing in proportion to somatic growth, whereas saphenous vein grafts tend to course in a more linear way, with no increase in length or diameter.…”

“…2,3 Aggressive lipid lowering with LDL apheresis and plasmapheresis is extremely important to prevent recurrence, and new lesions occur if total cholesterol remains greater than 220 mg%. 4,5…”