Effects of pravastatin on thoracic aortic atherosclerosis in patients withheterozygous familial hypercholesterolemia

Data regarding the effects of plasma lipid lowering on the evolution of tho racic aortic atherosclerosis (TAA) are scarce. In this study, we performed transesophageal echocardiography to characterize TAA in 16 newly diagnosed patients with heterozygous familial hypercholesterolemia and to follow its evolution after 2 years of statin treatment. TAA wets graded as follows: gr ade I = normal intima; grade II = increased intimal echo density without th ickening; grade IIIA = increased intimal echo density with single atheromat ous plaque less than or equal to 3 mm; grade IIIB = multiple plaques less t han or equal to 3mm; grade IV = greater than or equal to 1 plaque >3 mm; an d grade V = mobile or ulcerated plaques. Baseline aortic intimal morphology was grade I in one patient, grade II in 4, grade IIIA in 6, grade IIIB in 3, and grade IV in 2 patients. Hypolipidemic treatment resulted in signific ant reductions in plasma total cholesterol and low-density lipoprotein (LDL ) cholesterol. Follow-up aortic morphology was grade I in 5 patients, grade II in 2, grade IIIA in 3, grade IIIB in 3, and grade IV in 3 patients. TAA remained stable in 7 patients, progressed in 3, and regressed in 6 patient s. TAA evolved in a uniform manner in the ascending aorta, aortic arch, and descending aorta. Patients with TAA regression were younger (39 +/- 14 vs 52 +/- 8 years, p = 0.038) and had a greater decrease in plasma LDL cholest erol as a result of treatment (138 +/- 56 vs 73 +/- 55 mg/dl, p = 0.036) th an patients with TAA stability or progression. These observations support t he hypothesis that hypolipidemic treatment may favorably affect the course of TAA in patients with heterozygous familial hypercholesterolemia. (C) 199 8 by Excerpta Medica, Inc.