Key result
Men with heterozygous familial hypercholesterolemia reached higher median peak systolic and diastolic blood pressures during exercise testing.
Why the study?
Heterozygous familial hypercholesterolemia leads to premature CAD, but whether subclinical pathophysiologic consequences can be detected prior to clinically overt CAD using stress testing and myocardial strain imaging remained to be evaluated.
Does heterozygous familial hypercholesterolemia alter blood pressure response during exercise and left ventricular global longitudinal strain in asymptomatic men?
Case-Control (n=85)
No
Does heterozygous familial hypercholesterolemia alter blood pressure response during exercise and left ventricular global longitudinal strain in asymptomatic men?
Asymptomatic men with heterozygous familial hypercholesterolemia exhibit an exaggerated blood pressure response to exercise and slightly impaired global longitudinal strain, suggesting the presence of early subclinical vasculopathy and myocardial dysfunction.
Answers are grounded in this paper and cite their sources.
Exaggerated exercise BP response may signal early vasculopathy in asymptomatic heFH men; leaves open its prognostic value and need for longitudinal validation.
BACKGROUND: Heterozygous familial hypercholesterolemia (heFH) is a genetic disorder leading to premature coronary artery disease (CAD). We hypothesized that the subclinical pathophysiologic consequences of hypercholesterolemia may be detected before the occurrence of clinically overt CAD by stress testing and myocardial strain imaging. PATIENTS-METHODS: We evaluated the treadmill tests (ETTs) of 46 heFH men without known arterial hypertension/diabetes mellitus/vasculopathy like CAD and of 39 healthy men matched for age, baseline systolic/diastolic blood pressure (BP) and heart rate (HR), using Bruce protocol. Global longitudinal strain (GLS) of the left ventricle (LV) additionally to ejection fraction was obtained. RESULTS: heFH men reached a significantly higher peak systolic and diastolic BP compared to controls (p = 0.002 and p < 0.001, respectively). Mean rate pressure product was significantly higher in heFH patients (p = 0.038). Both duration of the ETT and workload in metabolic equivalents was lower in the heFH group (p < 0.001 and p < 0.001, respectively). Baseline to peak rise of systolic and diastolic BP in heFH men was higher (p = 0.008 and p < 0.001 for systolic and diastolic BP, respectively). Furthermore, heFH men had higher rise of HR from baseline to peak, compared to controls; (p = 0.047). GLS in heHF men was slightly decreased (p = 0.014), although the ejection fraction was similar in both groups. CONCLUSION: heFH men have a higher rise in systolic/diastolic BP during ETT, which may reflect early, preclinical hypertension. Furthermore, slight impairment of LV GLS is present, despite the absence of apparent myocardial dysfunction in conventional 2D echocardiography.
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Vartela et al. (2021) conducted a case-control in Heterozygous familial hypercholesterolemia (n=85). Heterozygous familial hypercholesterolemia vs. Healthy matched controls was evaluated on Peak systolic blood pressure during exercise treadmill testing (p=0.002). Men with heterozygous familial hypercholesterolemia reached higher median peak systolic and diastolic blood pressures during exercise testing.
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