Usefulness of electron beam tomography in adolescents and young adults with heterozygous familial hypercholesterolemia

Background-Because of the success of secondary prevention of coronary event s by intense risk factor modification, a more precise measure of atheroscle rosis in youth would have great clinical value both in the design of clinic al trials for the demonstration of the usefulness of coronary disease preve ntion early in life and in guiding therapy. Identification of calcium in co ronary arteries by electron beam tomography has been associated with severi ty of atherosclerosis in adults. Methods and Results-Twenty-nine youths 11 to 23 years old with familial hyp ercholesterolemia (average LDL cholesterol, 5.95 mmol/L) underwent electron beam tomography as well as comprehensive risk factor assessment with measu rement of total cholesterol, triglycerides, HDL cholesterol, lipoprotein (a ), apolipoprotein E phenotype, blood pressure, body mass index, and history of tobacco use. Significant coronary calcium was identified in 7 of 29 sub jects. increased body mass index was significantly associated with the pres ence of coronary calcium (25.3 versus 20.6 kg/m(2), P<0.03). No other risk factors were associated with the presence of coronary calcium. Conclusions-Coronary calcium, uncommonly identified before the fourth decad e, was found in a significant percentage of adolescents and young adults wi th familial hypercholesterolemia. Overweight may increase the likelihood of coronary calcium being present in individuals already at high risk.