Abstract 14995: Family History of Coronary Artery Disease in Patients With Vasospastic Angina: What Does it Mean Clinically?

Abstract

Introduction: It has been reported that a family history of coronary artery disease (FH-CAD) is one of the coronary risk factors for CAD with organic coronary stenosis (o-CAD). Hypothesis: However, the indication for FH-CAD in patients with vasospastic angina (VSA) is yet to be fully elucidated. Therefore, we investigated the frequency of FH-CAD in patients with VSA and examined the clinical characteristics of patients with VSA with FH-CAD. Methods: A total of 78 patients with VSA diagnosed by coronary angiography and spasm provocation test (SPT) were included. Patients with cardiomyopathies, long QT syndrome, or Brugada syndrome, were excluded. On SPT, VSA was defined as >90% narrowing of coronary artery in response to acetylcholine accompanied with chest symptoms and/or ST- T changes on ECG. Each patient was interviewed about their FH-CAD, and its presence was defined as having known CAD and sudden cardiac death affecting first-degree relatives. According to the presence of FH-CAD, patients with VSA were classified into the two groups: Group I, with FH-CAD; and Group II, without FH-CAD. Conventional risk factors, blood chemical parameters, vascular function, including flow-mediated dilation (FMD) and nitroglycerin-induced dilation (NID), duration of angina, were checked. Furthermore, the frequency of FH-CAD was checked in 161 patients with o-CAD (≥50% coronary stenosis) and 69 patients without o-CAD or VSA (non-CAD) . Results: Group I and Group II comprised 17 (21%) and 61 patients (79%), respectively. The frequency of FH-CAD in patients with VSA was not significantly different between o-CAD and non-CAD groups (17% vs. 16%). The conventional coronary risk factors, blood chemical parameters, and FMD (3.2 ± 3.1%, vs. 3.4 ± 3.8%) were not significantly different between Group I and Group II. In contrast, NID and duration of angina were significantly higher in Group I than in Group II, (18.2 ± 9.1% vs. 14.0 ± 5.2%; 52 ± 15 months vs. 16 ± 7 months, respectively; both p < 0.05). Conclusions: These findings suggest that the FH-CAD is associated with the duration of angina and abnormal vascular smooth muscle function. Thus, FH-CAD may provide clinically important information regarding the activity and the possible mechanism, even in patients with VSA.