Carotid artery plaques – are risk factors the same in men and women with familial hypercholesterolemia?

Abstract Background and aims High low-density lipoprotein (LDL)-cholesterol levels are a major cause of premature coronary heart disease (CHD) and death in patients with familial hypercholesterolemia (FH). It is uncertain whether these risk factors affect men and women equally. We aimed to compare the risk factors of carotid plaques, which are reliable surrogates of coronary atherosclerosis, in men and women with FH. Methods 154 patients with FH (40.9% men) were included, diagnosed according to Simon Broome criteria. Carotid plaques were assessed by ultrasound. Results In women multiple logistic regression analysis revealed that systolic blood pressure, high-density lipoprotein-cholesterol (HDL-C), apolipoprotein (apo) A1, and alanine aminotransferase (ALT) were associated with the presence of carotid plaques. In this female cohort, the age adjusted odds ratio for the increase of HDL-C by 1 standard deviation was related to a 55% decrease in the odds of having carotid plaques ( p = 0.01) and the age adjusted odds ratio for the increase of ALT by 1 U/l was related to a 7% in the increase odds of having carotid plaques ( p = 0.02). In men, in multiple logistic regression analysis only apo B concentration was significantly related to carotid plaque presence. The odds ratio for the increase of apo B by 1 mg/dl corresponded to a 4% increase in the odds of having carotid plaques ( p = 0.01) and, interestingly, in men not treated with statin, this ratio reached 8% ( p = 0.04). Conclusions In summary, our study suggests a difference in risk factors of carotid artery plaques between men and women with FH.