Intima-media thickness in treated and untreated patients with and without familial hypercholesterolemia: A systematic review and meta-analysis

Kika van Bergen en Henegouwen, Barbara A. Hutten, Ilse K. Luirink, Albert Wiegman, Eric de Groot, D. Meeike Kusters

Research output: Contribution to journalReview articleAcademicpeer-review

4 Citations (Scopus)


Familial hypercholesterolemia (FH) is a common genetic disorder of lipoprotein metabolism leading to premature atherosclerosis. From early onset, status and progression of atherosclerosis of the large peripheral arterial walls can be quantified by ultrasound intima-media thickness (IMT) measurements. Here we describe differences in IMT in treated and untreated FH patients versus unaffected controls over a broad age range. We conducted a systematic literature search using MEDLINE, EMBASE and up to April 2020 for studies addressing IMT in FH patients and controls. Our search yielded 558 articles of which 42 (6,143 participants) were included. Meta-analysis showed a mean (95%CI) difference between FH patients vs controls of 0.11 (95%CI 0.06-0.15) mm in carotid IMT (p<0.001), and 0.47 (0.19-0.74) mm in femoral IMT (p <0.001). We found a smaller mean (95%CI) difference in carotid IMT in treated FH patients vs controls: 0.05 (0.03-0.08) mm (p <0.001), than in untreated FH patients vs controls 0.12 (0.03-0.21) mm (p=0.009). When plotted against age, the mean (95%CI) difference in carotid IMT between FH patients vs controls increases with 0.0018 (-0.0007-0.0042) mm/year. This increase was smaller in treated vs untreated FH patients, when compared to controls (0.0023 (0.0021 to 0.0025) mm/year vs 0.0104 (0.0100-0.0108) mm/year, respectively). Our findings suggest that more robust earlier treatment initiation and achieving treatment targets could be beneficial to reduce cardiovascular risk in patients with FH.

Original languageEnglish
Pages (from-to)128-142
Number of pages15
JournalJournal of clinical lipidology
Issue number2
Early online date2022
Publication statusPublished - 1 Mar 2022


  • Atherosclerosis
  • Cholesterol
  • Dyslipidemias
  • Familial hypercholesterolemia
  • Hyperlipidemia
  • Intima-media thickness
  • Lipid modifying drugs
  • Statins
  • Ultrasound

Cite this