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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.