THE PREVALENCE OF PERIPHERAL VASCULAR-DISEASE IN FAMILIAL HYPERCHOLESTEROLEMIA

Objectives. In patients with familial hypercholesterolaemia (FH), the prevalence of haemodynamically significant peripheral vascular disease (PVD) was measured in relation to lipoproteins, general risk factors and the presence of coronary artery disease (CAD). Design. A case cont rol study. Setting. The outpatient lipid clinic of a university hospit al (tertiary referral centre), Subjects. Patients with heterozygous FH [n = 68; age 45.8 +/- 11.6 years; untreated LDL-cholesterol 9.2 +/- 2 .0 mmol L(-1)] were compared with control subjects matched for gender, age, weight, smoking and presence of hypertension [n = 27; age 44.0 y ears; LDL-cholesterol 3.8 +/- 1.3 mmol L(-1)]. Main outcome measures. PVD was assessed during cholesterol-lowering treatment using ankle/arm blood pressure ratios and analyses of Doppler-derived blood now veloc ities in the femoral artery at rest and during reactive hyperaemia. Th e diagnosis of CAD was assessed clinically, Results. Haemodynamically significant PVD was found in 21 (31%) FH patients and in one (3.7%) co ntrol subject, predominantly localized in the femoro-popliteal vessels . CAD was present in 30 (44.1%) FH patients and in one (3.7%) control subject, PVD could be demonstrated in 50% of FH patients with CAD [rel ative risk 3.2 (95% CI 1.4-7.2)] and in 19% as the first manifestation of vascular disease. Males and females were equally affected. Mean ar terial blood pressure of FH patients with PVD was higher compared to F H patients without PVD. Conclusions. Haemodynamically significant PVD appears to be more prevalent in FH patients than is generally assumed, especially in those with CAD, A relation with lipoprotein levels coul d not be demonstrated.