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3 41 | Carotid ultrasonography in statin treated FH The association of carotid plaque presence and C-IMT on ASCVD outcome has not been studied in statin-treated FH patients. Despite this lack of evidence many cohort and intervention studies have used C-IMT as a proxy of ASCVD outcome in statin-treated FH patients (18,26,31,32). Since in our study in statin-treated FH patients C-IMT did not associate with coronary calcification, C-IMT might not be useful as a marker for ASCVD risk in these patients. The case-control designof our study limits the possibility toobserve changes inplaque presence and C-IMT over time. Since no prospective ultrasound data is available for our patients, we cannot assess whether ultrasonographic changes over time are associated with cardiovascular risk. Clinical characteristics differed slightly between patients and controls. The controls were of similar age, but more often women. Therefore, it is unlikely that better gender-matched controls will unmask a hidden burden in our treated FH cohort. Since the results were similar in both groups and the C-IMT values were similar to other healthy populations (9,22,24,25), and adjustment for these differences had no influence, it is unlikely that these differences have affected the outcome of our study. We did not include data of compound heterozygous FH patients and homozygous FH patients, because their baseline and treated LDL-C as well as their ASCVD risk is not comparable to heterozygous FH patients. Carotid plaques were only scored as present or absent whilst plaque volume measurements may be a better way to score cardiovascular risk (14,33). However, this can only be done with 3D ultrasonography which was not available on our ultrasound system. Therefore, we cannot exclude that other ultrasonographic techniques or locations may yield different results. Conclusion CarotidplaquesandC-IMTdidnotdifferbetween long-termstatin-treatedheterozygous- FH patients and healthy controls. This shows that long-term statin treatment in these FH patients reduces carotid atherosclerosis to a degree of a healthy population. These findings strongly suggests that sonography of the carotid arteries during follow-up of statin-treated FH patients has limited value. Conflicts of interest There was no relationship with industry that could cause a conflict of interest.