25-Year Comparison of Coronary Lesions Anatomy in Two Cohorts of French Canadians with Familial Hypercholesterolemia.

Over the past decades, new treatments and guidelines have been introduced for the screening and management of familial hypercholesterolemia (FH). However, the impact of these medical and scientific advances on the characteristics and burden of coronary lesions over time in FH remains poorly documented. The primary goal of this study is to determine the characteristics of coronary lesions in HeFH patients who underwent coronary angiography within two distinct timeframes: the last five years versus those who had the procedure at the same hospital 25 years earlier. The characteristics of coronary lesions in 108 HeFH patients who consecutively underwent coronary angiography for CAD between 2017 and 2022 (2022 cohort) were compared to those of 240 patients who had an angiography between 1995 and 1998 (1998 cohort). Compared to 1998, FH patients requiring coronary angiography were proportionally less numerous and significantly older in 2022 ( < 0.001). Although the number of coronary lesions (2.5 ± 1.5 in both cohorts) and the proportions of multi-vessel (70.4% vs. 70.2%), three-vessel (29.6% vs. 30.2%) and left main involvement (15.7% vs. 16.0%) did not differ significantly in 2022 compared to 1998, proximal involvement (57.7% vs. 79.5%) and total occlusion (26.8% vs. 52.7%) were less frequently observed in 2022 ( < 0.001) and referral to bypass grafting (CABG) decreased by >50% from 1998 to 2022 (15.5% vs. 39.8% < 0.001). Over a 25-year period, the incidence of total coronary artery occlusion and the need for CABG among adults with FH from a high-prevalence founder population were reduced by more than 50% and occurred in older ages. However, the absence of major improvement of coronary anatomy severity underscores the persistently high cardiovascular risk in FH patients.