3-year prospective follow-up of patients with heterozygous familial hypercholesterolemia in childhood: focus on predictors of vascular remodeling
DOI:
https://doi.org/10.34687/2219-8202.JAD.2024.02.0005Keywords:
Семейная гиперхолестеринемия, дети, толщина комплекса интима-медиа, сосудистое ремоделирование, проспективное исследованиеAbstract
Aim. To study age-related features of the thickness of the intima media complex of the common carotid artery in patients with heterozygous familial hypercholesterolemia in childhood based on a 3-year prospective observation.
Materials and methods. The study was carried out between 2017 and 2023. It involved 243 children aged 5 to 17 years (median 11 [7.0 – 15.0]), of which 122 children were diagnosed with familial hypercholesterolemia, heterozygous form (FH), included in the main group. The control group consisted of 121 healthy children. Children in the control and main groups were divided into 3 age subgroups: 5–7 years, 8–12 years, 13–17 years. The dynamic 3-year study included 4 visits with an interval of 11-13 months (average interval 12 months). All children underwent instrumental examination methods: electrocardiogram recording, echocardiography, 24-hour blood pressure monitoring, duplex ultrasound examination with assessment of the thickness of the intima-media complex (IMT) of the common carotid artery automatically using QApps software.
Results. Based on the results of a 3-year prospective observation, it was found that in childhood, the IMT increases in both the control and main groups, however, in patients with FH, the average annual increase in IMT is 1.8 times higher relative to the control group (0.009 mm and 0.005 mm, respectively, p<0.001). During observation, among patients with FH, the proportion of people with vascular remodeling in the form of pathological indicators of IMT increased from 57.3% to 70.5% (p <0.05). When analyzing gender differences in IMT indicators, no statistically significant differences were found between boys and girls.
Conclusion. In children with heterozygous familial hypercholesterolemia, signs of vascular remodeling have been established, characterized by thickening of the intima-media complex of the common carotid artery from 8-12 years of age. Over a 3-year observation period, negative dynamics of vascular remodeling according to average PWV was observed in 18.6%, and IMT - in 13.2% of patients. The results obtained highlight the need for dynamic instrumental examination of vessels in children with familial hypercholesterolemia.
Keywords. Familial hypercholesterolemia, children, intima-media thickness, vascular remodeling, prospective study.
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