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The presence of familial hypercholesterolemia requires special attention from the attending physician to the risk of developing coronary disease at an early age and without significant clinical symptoms.
Although the common age for the development of coronary disease in this type of patient is the end of the second decade and the third decade, many reports have indicated the possibility of developing coronary disease at an earlier age, especially in patients with poor control of the level of cholesterol or patients of the type homozygous.
The management of patients with FH with coronary disease depends on two parts, the first is medical and the second is surgical, as there is no long-term benefit from surgery unless total cholesterol level is strictly controlled, the researches indicate that achieving a total blood cholesterol level of less than 220 mg is of utmost importance to prevent the development of existing coronary disease as well as to prevent the occurrence of new coronary injuries.4,5
The benefits of using arterial grafts in particular in FH patients have been documented in several studies in terms of long-term survival as well as freedom from coronary revascularization.6,7
The comparison between the use of the right internal thoracic artery as a second graft (after using the left internal thoracic artery for grafting the anterior descending artery) and the saphenous vein is demonstrated by a meta-analysis of the superiority of the right internal thoracic artery in terms of long-term survival with a higher risk of deep sternal wound infection.8
The presence of coarctation of the aorta causes harm to coronary disease because it causes an increase in left ventricular end-diastolic pressure and thus resistance to blood flow in the coronary arteries.
Treatment of aortic coarctation is of great importance for coronary disease, but since the narrowing is not severe, its treatment can be postponed to a later stage.