The Danish Familial Hypercholesterolemia Organized Coronary Screening Trial

Condition(s) studied

Investigational drug(s) / intervention(s)

Visualization of coronary Imaging and oral description: The participants is allowed to see their coronary CT scan including oral description. The study will test the effect on smoking habit and changes in LDL-C in one year.

Study summary

Familial hypercholesterolemia (FH) is the most common inherited cause of atherosclerotic cardiovascular disease (ASCVD) with a prevalence of approximately one in 200 individuals, however only few of the estimated 30.000 patients with FH in Denmark has been diagnosed. FH is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature ASCVD in particular coronary artery disease. The presence of atherosclerosis measured by cardiac computed tomography (CT) is a reliable predictor of future cardiovascular events and may help guide clinicians with regard to the lifestyle modifying therapies and lipid-lowering treatment. However, the prevalence and degree of coronary atherosclerosis in Danish FH patients without symptoms of ASCVD is unknown.

Therefore, the invetigators aimed to:

* Screen FH patients in a Danish setting for subclinical coronary atherosclerosis to improve lipid-lowering treatment and,
* Test if coronary CT screening can help to reach LDL-C therapy goals and reduce smoking.

This study will consist of a local cross sectional pilotstudy including 100 asymptomatic FH patients recruited from the lipid clinic at Odense University Hospital and hereafter a regional cross-sectional on approximately 600 asymptomatic FH patients in the Region of Southern Denmark recruited from the lipid clinics trough the national patient registry. In the pilot study, patients will undergo lipid analysis and non-contrast / contrast CT for description of coronary arterial calcium, and plaque morphology in this patient group. This will provide knowledge for planning the regional cross sectional study describing subclinical atherosclerosis in this population. Patients will furthermore be randomized to see their coronary CT scan or not. Mean LDL-C change and smoking status will be evaluated one year after.

The benefit of finding subclinical atherosclerotic disease with the possibility to improve lipid-lowering treatment for prevention of future premature ischemic heart disease is considered to outweigh the minor radiation exposure in this trial. If LDL-C is reduced significantly and smoking reduction is significant trough a simple intervention as showing the CT scan to the patient, this study can provide knowledge whether CT screening of this patient group should be considered in Denmark.

Eligibility

Primary outcome measure(s)

• Coronary arterial calcium score (CACS) — 18 months
  Mean CACS of the population
• CACS — 18 months
  Median CACS of the population
• Plaque composition — 18 months
  proportion of soft and calcified plaques
• Plaque volume (mean) — 18 months
  Mean size of plaques described in mm.
• Plaque volume (median) — 18 months
  Median size of plaques described in mm.
• Severity of stenosis (number of stenosis) — 18 months
  Percentage of vessel lumen compromised by plaque described as number of minor, moderate and severe stenosis.
• Severity of stenosis (proportion of stenosis) — 18 months
  Percentage of vessel lumen compromised by plaque described as proportion of minor, moderate and severe stenosis.

Trial sites (1)

More Odense University Hospital trials in Denmark

Other trials for the same condition