35yo caucasian male, amateur endurance runner (15h/w), RHR 45bpm, lean 80kg/183cm, healthy diet, never smoked, non-drinker.
Childhood (5yo) Kawasaki disease coronary aneurysms: fusiform dilation of proximal LAD and 7-8mm spherical aneurysm on RCA.
By age 19, coronary aneurysms had fully regressed to normal luminal diameter, zero stenosis, and strictly extra-luminal calcification.
Recently experienced an altitude-triggered hypertensive crisis (170 BP) → investigated with cardio:
- CAC 525
- CCTA: mild (25–49%) stenosis in the proximal LAD (eccentric mixed plaque) and in the mid RCA (arc-like calcification); zero aneurysms remaining
- 48h Holter: non-remarkable
- 24h ABPM: non-dipping pattern (systolic only -2% at night)
… DESPITE (UNMEDICATED):
- ApoB 73 mg/dL
- LDL 3.00 mmol/L (1.87 mmol/L 2 years before hypertensive crisis)
- hs-CRP 1.33 mg/L (<0.34 mg/L 2 years before hypertensive crisis)
- Lp(a) <10 mg/dL
- Fasting glucose 4.5 mmol/L
Cardio put me on:
- Rosuvastatin 10mg + Ezetimibe 10mg
- Telmisartan 80mg + Amlodipine 5mg
- Aspirin 100mg
Medicated outcome:
- ApoB 51 mg/dL
- LDL 1.41 mmol/L
- hs-CRP 0.98 mg/L
- BP 110/65
Kawasaki is a rare condition so it is hard to find answers on targets to stabilise/regress plaque. I wonder:
-
ApoB: Target even lower? Add a PCSK9i and/or Bempedoic Acid? (wary of BA due to the tendon rupture risk with high running volume)
-
Aspirin: Aneurysms fully regressed + recent low altitude epistaxis while medicated: does the haemorrhagic risk outweigh the prophylactic protection against cap rupture at 25–49% mixed stenosis? - Family history: one grandparent died of aortic dissection, another of haemorrhagic stroke, and my mother had two thrombotic strokes in her 40s linked to ultra-high BP (230 unmedicated and 150-160 medicated).
-
CRP: Target even lower? Low-dose colchicine?