White matter brain lesions in midlife familial hypercholesterolemic patients at 3-tesla magnetic resonance imaging

Background: Patients with hypercholesterolemia of 60 years and older have an increased risk for white matter brain lesions and dementia. Purpose: To investigate whether patients with familial hypercholesterolemia (FH) develop white matter lesions at 3-Tesla (T) MRI as early as in midlife. Material and Methods: Non-diabetic, nonsmoking, and non-hypertensive heterozygous FH patients on treatment with maximally tolerated dose of a statin for more than 5 years (n=14) and matched controls (n=22) aged 25 to 60 years of age were studied. Imaging was performed at 3T with a fluid-attenuated T2-weighted MR pulse sequence and a T1-weighted spin-echo pulse sequence following 10ml of i.v. gadopentetate dimeglumine. Images were evaluated by two independent readers. Fasting blood samples were taken. Student's t test was employed at P0.05. Results: Three volunteers and one FH patient had white matter lesions (P0.53). No other evidence of past ischemic stroke was observed. Mean total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly higher in the FH group (6.01.1 vs. 5.10.9mmol/l, P0.02 and 4.10.9 vs. 3.10.8mmol/l, P0.004, respectively). Conclusion: Heterozygous FH patients on statin treatment in the age range of 25 to 60 years are not at increased risk of white matter lesions at 3T MRI.