Robinson - Figure 15 - NO non-invasive imaging Text

Finally, the FNLA recommended that noninvasive imaging for atherosclerosis should not be performed in FH patients. Again, the reasoning was that basically subclinical atherosclerosis in FH patients is very common. On the other hand, half of FH patients may have a normal noninvasive test, whether a coronary artery calcium score or carotid IMT, and then go on and have a CHD event within the next 5 years. Therefore it does not make any difference whether there is a positive noninvasive test score or not; every FH patients should still be treated with drugs, with intensification based on the number of additional risk factors. Obviously, if one of your patients does undergo noninvasive imaging and the result is positive, then you might decide to intensify therapy even more – but if the noninvasive test score should be negative or suggest the absence of atherosclerosis, it should be ignored and should not be a factor at all in your clinical decision making.

Robinson J. J Clin Lipidol. 2011; 5(6).