所属 医学部 医学科（東京女子医科大学病院） 職種 准教授
|発表タイトル||Aortic Valve Calcification and Subclinical Coronary Atherosclerosis in Japanese Heterozygous Familial Hypercholesterolemia Patients With High Lp(a) Levels|
|会議名||American Heart Association (AHA) Scientific Sessions 2019|
|主催者||American Heart Association (AHA)|
|発表者・共同発表者||◎SAKAI Akiko, SATO Kayoko, SEKIGUCHI Haruki, NAGAO Michinobu, SAKAI Shuji, HAGIWARA Nobuhisa|
|概要||Introduction: Heterozygous familial hypercholesterolemia (HeFH) is caused by mutations of FH genes that causes premature cardiovascular disease in patients. On the other hand, aortic valve calcification (AVC) is associated with an elevated risk of cardiovascular events. However, it is not known the association of LP(a) levels and AVC in HeFH.
Objectives: We investigated whether AVC associated with the coronary plaque morphology in HeFH patients with high LP(a) levels.
Methods: We enrolled 89 patients included 62 HeFH, 27 suspected of HeFH, (s/o HeFH) according to the guideline of the Japanese Atherosclerosis Society. We evaluated RHI, ABI, PWV, IMT and lipid profile, such as ApoB, oxidized LDL, RLP-C, Lipoprotein(a) [LP(a)]. AVC score, and coronary artery plaque score (CAPS) were examined by 320 detector row CT. The genotypes were analyzed using Illumina Mi-seq sequencer.
Results: Twenty-one patients (33%) with HeFH had gene mutations of LDLR and PCSK9. AVC was detected more frequently, and AVC score was higher in HeFH patients with gene mutation. According to the high LP(a) group (>40mg/dl) versus low LP(a) group (≦40mg/dl), HeFH patients with high LP(a) group had increased AVC score (108±28 vs 35±15, P=0.025) . AVC score was significantly correlated with CAPS (R=0.46, p<0.01). Furthermore, HeFH patients with coronary artery disease (CAD) had significantly high AVC score and CAPS more than that patients without (P=0.005).
Conclusions: In HeFH patients, the levels of LP(a) is associated with AVC. The AVC score was related to coronary plaque morphology. Evaluating Lipoprotein(a) might be helpful to assess risk stratification in HeFH patients and to determine the treatment strategy for preventing the future cardiovascular events.