Compliance of the aorta in two diseases affecting vascular elasticity, familial hypercholesterolemia and diabetes: a MRI study

Sami Soljanlahti¹, Taina Autti¹, Laura Hyttinen², Alpo F Vuorio³, Pekka Keto¹, Kirsi Lauerma¹

¹Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland; ²Department of Internal Medicine, North Karelia Central Hospital, Joensuu, Finland; ³Division of Internal Medicine, Department of Medicine, University of Helsinki, Helsinki, Finland

Abstract: Arterial elasticity changes in familial hypercholesterolemia (FH) and diabetes mellitus (DM) with different but overlapping mechanisms. We compared aortic elasticity between 19 FH patients with the same mutation, 18 type 2 DM patients, and 30 controls, all aged 48 to 64. They underwent aortic magnetic resonance imaging, risk-factor assessment, and carotid and femoral ultrasound measurements. All patients were on adequate cardiovascular medication including statins and had established coronary heart disease (CHD). FH patients had longer-duration CHD (13.3 ± 7.7 years) than did DM patients (5.0 ± 3.1). Aortic compliance in the descending thoracic (DM 0.38 ± 0.14 vs control 0.53 ± 0.19, P = 0.032) and abdominal aorta (DM 0.45 ± 0.20 vs control 0.66 ± 0.25, P = 0.011) was lower in DM patients than in controls, whereas no significant difference existed between FH patients and controls. Carotid and femoral intima-media thickness was greater in FH and DM patients than in controls with no difference between patient groups. Carotid or femoral plaques appeared in 15 (79%) FH and in 10 (56%) DM patients. One control had a femoral plaque. Five FH patients showed stenosis, occlusion or both in carotid arteries. In our opinion, DM patients’ lower compliance reflect mainly arterial media affecting arteriosclerosis, while FH patients’ plaque status and longer duration of CHD suggest more advanced atherosclerosis. The FH patients may therefore be at increased risk for atherothrombotic events. However, due to small patient material, larger confirmatory studies are needed.

Keywords: MRI, ultrasound, familial hypercholesterolemia, diabetes mellitus, elasticity, intima-media thickness