{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:02:26Z","timestamp":1793091746786,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002996","name":"Dutch Heart Foundation","doi-asserted-by":"crossref","award":["04-001-2021-0078"],"award-info":[{"award-number":["04-001-2021-0078"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Familial hypercholesterolaemia (FH) patients are subjected to a high lifetime exposure to low density lipoprotein cholesterol (LDL-C), despite use of lipid-lowering therapy (LLT). This study aimed to quantify the extent of subclinical atherosclerosis and to evaluate the association between lifetime cumulative LDL-C exposure and coronary atherosclerosis in young FH patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Familial hypercholesterolaemia patients, divided into a subgroup of early treated (LLT initiated &amp;lt;25 years) and late treated (LLT initiated \u226525 years) patients, and an age- and sex-matched unaffected control group, underwent coronary CT angiography (CCTA) with artificial intelligence-guided analysis. Ninety genetically diagnosed FH patients and 45 unaffected volunteers (mean age 41 \u00b1 3 years, 51 (38%) female) were included. Familial hypercholesterolaemia patients had higher cumulative LDL-C exposure (181 \u00b1 54 vs. 105 \u00b1 33\u2005mmol\/L \u2217 years) and higher prevalence of coronary plaque compared with controls (46 [51%] vs. 10 [22%], OR 3.66 [95%CI 1.62\u20138.27]). Every 75\u2005mmol\/L \u2217 years cumulative exposure to LDL-C was associated with a doubling in per cent atheroma volume (total plaque volume divided by total vessel volume). Early treated patients had a modestly lower cumulative LDL-C exposure compared with late treated FH patients (167 \u00b1 41 vs. 194 \u00b1 61\u2005mmol\/L \u2217 years; P = 0.045), without significant difference in coronary atherosclerosis. Familial hypercholesterolaemia patients with above-median cumulative LDL-C exposure had significantly higher plaque prevalence (OR 3.62 [95%CI 1.62\u20138.27]; P = 0.001), compared with patients with below-median exposure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Lifetime exposure to LDL-C determines coronary plaque burden in FH, underlining the need of early as well as potent treatment initiation. Periodic CCTA may offer a unique opportunity to monitor coronary atherosclerosis and personalize treatment in FH.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwae028","type":"journal-article","created":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T12:51:52Z","timestamp":1705755112000},"page":"892-900","source":"Crossref","is-referenced-by-count":31,"title":["Beyond early LDL cholesterol lowering to prevent coronary atherosclerosis in familial hypercholesterolaemia"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9944-299X","authenticated-orcid":false,"given":"Shirin","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurens F","family":"Reeskamp","sequence":"additional","affiliation":[{"name":"Department of Vascular 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A","family":"Bax","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Northwest Clinics , Alkmaar , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K","family":"Min","sequence":"additional","affiliation":[{"name":"Cleerly Inc. , Denver, CO , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P","family":"Earls","sequence":"additional","affiliation":[{"name":"Cleerly Inc. , Denver, CO , USA"},{"name":"The George Washington University School of Medicine , 2150 Pennsylvania Avenue NW, Washington, 0037 DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Knaapen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam , De Boelelaan 1117, 1081 HV Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6223-5671","authenticated-orcid":false,"given":"Albert","family":"Wiegman","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik S G","family":"Stroes","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9045-6009","authenticated-orcid":false,"given":"Nick S","family":"Nurmohamed","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 AZ Amsterdam , the Netherlands"},{"name":"The George Washington University School of 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