Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Background: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Methods and Results: Atherosclerotic risk factors and carotid intima-media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81 +/- 6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55 +/- 0.1 mm vs 0.58 +/- 0.08 mm: Delta IMT=0.04mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4 +/- 1 mmol/L vs 4.9 +/- 1 mmol/L; P=0.02), as well as lower thrombocyte levels (173 +/- 81x10(9)/L vs 255 +/- 54x10(9)/L; P<0.01), higher bilirubin levels (18.6 +/- 11 mu mol/L vs 12.7 +/- 6 mu mol/L; P<0.01), and lower diastolic and systolic blood pressure (71 +/- 9 mmHg vs 76 +/- 9 mmHg, P<0.01; 113 +/- 14 mmHg vs 124 +/- 12 mmHg, P<0.01, respectively). Conclusions: In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels. (Circ J 2010; 74: 1436-1441)