15289-s-bos

1 11 | Introduction Carotid ultrasonography Carotid ultrasonography can be used to measure subclinical atherosclerosis depicted as the presence of carotid plaques or increased carotid intima-media thickness. Both of these outcomes have been associated with CVD risk in the general population (16-18). However, data lacks about the association between carotid ultrasonography outcomes and CVD in FH patients. Moreover, statin-treatment influences the ultrasonography outcomes. Both in FH as in non-FH patients it was shown that statins decrease C-IMT. However, whether carotid ultrasonography outcomes during statin-treatment are still useful for risk prediction has not been established. Coronary imaging CTCA is mainly used in symptomatic patients, who present with thoracic chest pain suspected to derive from atherosclerotic disease of the heart. One of the outcomes of the CTCA is the Agatston calcium score, which is calculated based on the intensity, volume and quantity of the calcific (white) signal on the CTCA-scans (19). This score is associated with cardiovascular events, and can improve risk prediction in the general population (20-24). In 2011, we performed a study in 101 asymptomatic FH patients to determine subclinical coronary atherosclerosis showing a wide variety of coronary artery calcification score (CAC-score), and CAC was more abundant in long-term, aggressively statin-treated FH patients than in untreated controls (25). The diversity of CAC scores in FH patients has been party explained by the higher CAC score in those FH patients with LDLR null-mutations compared to LDLR-defective mutations.(26). Aortic valve calcification Aortic valve calcification (AoVC) has an estimated prevalence of >50% in the elderly (>75 years) and is associated with 50% higher risk of CVD events (27,28). In homozygous FH, AoVC has a prevalence of 100%, and many of these patients need surgical intervention of functional valvular disease (29,30). Heterozygous FH is associated with less aortic valve dysfunction on echocardiography than homozygous FH (31-34). However, the prevalence and extent of aortic valve calcification (AoVC) is unknown in long-term, statin-treated heterozygous FH patients. Statins seem to have little effect on the progression of AOVC in the general population (35-37). Therefore this group is of particular interest, since statin therapy is the main reason for the prolonged survival in these patients (38). In this thesis, I present the first comparison between the prevalence of AOVC in heterozygous FH and non-FH patients.