AIMS The objective of this study was to evaluate if vascular age derived from coronary artery calcium (CAC) score improves atherosclerosis cardiovascular disease (ASCVD) risk discrimination in primary prevention asymptomatic heterozygous familial hypercholesterolaemia (FH) patients undergoing standard lipid-lowering therapy. METHODS AND RESULTS Two hundred and six molecularly confirmed FH individuals (age 45 ± 14 years, 36% males, baseline LDL-cholesterol 6.2 ± 2.2 mmol/L; 239 ± 85mg/dL) were followed by 4.4 ± 2.9 years (median: 3.7 years, interquartile ranges 2.7-6.8). CAC measurement was performed, and lipid-lowering therapy was optimized according to FH guidelines. Vascular age was derived from CAC and calculated according to the Multi Ethnic Study of Atherosclerosis algorithm. Risk estimation based on the Framingham equations was calculated for both biological (bFRS) and vascular (vaFRS) age. During follow-up, 15 ASCVD events (7.2%) were documented. The annualized rate of events for bFRS <10%, 10-20%, and >20% was respectively: 8.45 [95% confidence interval (CI) 3.17-22.52], 23.28 (95% CI 9.69-55.94), and 28.13 (95% CI 12.63-62.61) per 1000 patients. The annualized rate of events for vaFRS <10%, 10-20%, and >20% was respectively: 0, 0, and 50.37 (95% CI 30.37-83.56) per 1000 patients. vaFRS presented a better discrimination for ASCVD events compared to bFRS 0.7058 (95% CI 0.5866-0.8250) vs. vaFRS 0.8820 (95% CI 0.8286-0.9355), P = 0.0005. CONCLUSION CAC derived vascular age can improve ASCVD risk discrimination in primary prevention FH subjects. This tool may help further stratify risk in FH patients already receiving lipid-lowering medication who might be candidates for further treatment with newer therapies.

中文翻译：

---

从杂合性家族性高胆固醇血症患者的危险分层中，冠状动脉钙化评分得出的血管年龄。

目的本研究的目的是评估接受标准降脂治疗的一级预防无症状杂合子性家族性高胆固醇血症（FH）患者的冠状动脉钙化（CAC）分数衍生的血管年龄是否能改善动脉粥样硬化性心血管疾病（ASCVD）的风险识别。方法和结果206例经分子确认的FH患者（年龄45±14岁，男性36％，基线LDL-胆固醇6.2±2.2 mmol / L； 239±85mg / dL），其次是4.4±2.9年（中位数：3.7）年，四分位间距为2.7-6.8）。进行CAC测量，并根据FH指南优化降脂治疗。血管年龄源自CAC，并根据“多族裔动脉粥样硬化研究”算法进行计算。针对生物年龄（bFRS）和血管年龄（vaFRS），都基于Framingham方程计算了风险估计。在随访期间，记录了15次ASCVD事件（占7.2％）。bFRS <10％，10-20％和> 20％的年事件发生率分别为：8.45 [95％置信区间（CI）3.17-22.52]，23.28（95％CI 9.69-55.94）和28.13（每1000位患者有95％的可信度12.63-62.61）。vaFRS <10％，10-20％和> 20％的年事件发生率分别为：每1000名患者0、0和50.37（95％CI 30.37-83.56）。与bFRS 0.7058（95％CI 0.5866-0.8250）和vaFRS 0.8820（95％CI 0.8286-0.9355）相比，vaFRS对ASCVD事件表现出更好的辨别力，P = 0.0005。结论CAC衍生的血管年龄可以改善一级预防性FH受试者的ASCVD风险判别。