Coronary computed tomography and cardiovascular outcomes in genetically confirmed familial hypercholesterolemia
M Miname, F P M Maia, K P M Maia, V Z R Rocha, A P M Marte, F D C Castanhel, M H M Mizuta, O D Decanini, T R Reigas, C S A Alvo, J E K Krieger, R D S SantosAbstract
Background
Coronary computed tomography (CT) is increasingly used for cardiovascular risk stratification in familial hypercholesterolemia (FH)1. However, its impact on long-term cardiovascular outcomes and treatment intensification remains uncertain.
Purpose
To evaluate whether performing coronary CT is associated with improved cardiovascular outcomes and more intensive lipid-lowering therapy in genetically confirmed FH patients.
Methods
We analyzed 457 genetically confirmed FH patients in primary prevention. Patients were classified according to coronary CT performance (no coronary CT performed vs. coronary CT performed). Propensity scores were estimated using multivariable logistic regression and inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics (all SMD <0.07). Weighted Cox proportional hazard model was used to assess time-to-event outcomes, and weighted Kaplan–Meier curves was generated for event-free survival. Treatment intensification was evaluated using IPTW-weighted logistic regression, and LDL-C change was analyzed using IPTW-weighted linear regression.
Results
Before adjustment, patients undergoing CT were more frequently male and had higher BMI and highest LDL-C. After IPTW, all covariates were well balanced (all SMD <0.07). See table 1.
During follow-up 31 cardiovascular events occurred, median follow-up was 52 months (IQR 29–79). IPTW-adjusted Cox analysis showed that CT performance was associated with a significantly lower risk of cardiovascular events (HR 0.45, 95% CI 0.20–0.99). See Kaplan–Meier curves for cardiovascular events by coronary CT Status in figure 1.
Patients undergoing coronary CT were significantly more likely to receive intensive lipid-lowering therapy at follow-up (IPTW-adjusted OR 2.30, 95% CI 1.40–3.79; p=0.001). However, weighted linear models did not demonstrate a statistically significant difference in LDL-C reduction between groups (mean difference −13 mg/dL, p=0.18).
Conclusion
In genetically confirmed FH patients in primary prevention, coronary CT was associated with higher treatment intensification and a lower risk of cardiovascular events. These findings suggest that coronary CT risk stratification may encourage the use of more intensive lipid-lowering therapy and a consequent reduction in cardiovascular events.