Family History Of Premature Coronary Heart Disease Research Articles

Cardiac Rehabilitation of Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in a Han Population in Northern China: A Prospective Cohort Study.

BackgroundCardiac rehabilitation (CR) has been associated with improved cardiac function in cardiovascular diseases. Our aim was to explore the factors associated with cardiac function and CR.MethodsThis prospective cohort study had 473 STEMI patients admitted for primary percutaneous coronary intervention (PCI) who were divided into a CR group (group A, n = 104) and a non-CR group (group B, n = 369) based on whether they could complete CR. Patients’ clinical features, such as age, hyperlipidemia, family history of premature coronary heart disease (FHPCHD), smoking history, body mass index (BMI, kg/m2), number of diseased vessels, arrhythmia during PCI, N-terminal pro–B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACEs) at 6 months after PCI were compared. Then, the clinical characteristics of patients were further analyzed according to those with MACEs (n = 78) and those without MACEs (n = 395).ResultsAfter CR of 6 months, NT-proBNP levels (p = 0.027), 6-MWD (meter, P = 0.000), LVEF (P = 0.000) were significantly improved in group A compared to group B, but not for SMWA (P = 0.875). Multivariate analysis indicated that even though patients in group A (OR 3.06, 95% CI 1.132–8.274, p = 0.03) have a higher incidence of hyperlipidemia, their MACEs (OR 0.191, 95% CI 0.038–0.961, p = 0.05) at 6 months were significantly lower than in group B, mainly because the average patient low age (<65 years, OR 0.917, 95% CI 0.859–0.979, p = 0.01) and significant improvement of 6-MWD (OR 7.999, 95% CI 4.342–14.737, P = 0.00) and the LVEF at 6 months (OR 1.112, 95% CI 1.072–1.154, p = 0.00). Further analysis based on the MACES outcomes showed that there were 6 factors associated with the occurrence of MACEs, they were age >65 years (OR 1.032, 95% CI 1.009–1.009, p = 0.007), smoking history (OR 0.485, 95% CI 0.238–0.989, p = 0.046), education level (OR 2.646, 95% CI 1.370–5.108, p = 0.004), 6-MWD (OR 1.688, 95% CI 1.104–2.811, p = 0.044), LVEF (OR 0.958, 95% CI 0.926–0.991, p = 0.013) and CR (OR 6.271, 95% CI 2.236–17.590, p = 0.000).ConclusionCR, including exercise rehabilitation, is a beneficial option to reduce MACEs in STEMI patients treated with primary PCI.

Achilles tendon ultrasonography – A useful screening tool for cardiovascular risk estimation in patients with severe hypercholesterolemia

Background and aimsAchilles tendon lesions have long been associated with genetic defects in lipid metabolism and increased risk of cardiovascular diseases (CVD). With this study we aimed to evaluate the usefulness of Achilles tendon ultrasonography in identifying people at greater risk among subjects with severe hypercholesterolemia (SH) in a high-risk population. MethodsDuring the period of 2016–2017 a total of 213 participants were enrolled in this case-control study. Data of 110 patients with SH and 103 age and sex matched controls without dyslipidaeplemia and established CVD was collected. ResultsAchilles tendinopathy (AT) was present in 42.7% of subjects with SH and in 29.1% of controls (p = 0.039). Stronger association between SH and AT was seen in women – 24.1% vs 2.0% (p = 0.001). SH increased odds of AT by 1.815 (95% CI, 1.028–3.206). Prevalence of AT was higher in males despite presence (SH+) or absence (SH−) of severe hypercholesterolemia (SH+ 60.7% vs 24.1%, SH− 55.8% vs 2.0%, p < 0.001). AT was associated with higher proportion of subjects exceeding normal mean values of TC (80.5% vs 52.9%, p = 0.001), LDL-C (76.6% vs 52.2%), TG (54.5% vs. 22.1%), ApoB (57.1% vs 22.2%), ApoE (44.0% vs 22.4%) levels and ApoB/ApoA ratio (46.1% vs 21.5%) (p = 0.001) and family history of premature coronary heart disease (CHD). ConclusionsAT is more prevalent among subjects with SH and is associated with higher levels of TC, TG, LDL-C, ApoB, ApoE, ApoB/ApoA ratio, family history of premature CHD. SH increases the odds of developing AT.

Lipoprotein (a) and Cardiovascular Risk: The Show Must go on.

Lipoprotein (a) [Lp(a)] is an independent but moderate, predictor for coronary heart disease (CHD) prevalence and severity. Several established and emerging cardiovascular (CV) risk factors including age, gender, ethnicity, smoking, dyslipidemia, hypertension, obesity, type 2 diabetes mellitus, alcohol consumption, arterial stiffness and hyperuricemia have been linked to Lp(a) metabolism. Apart from CHD, Lp(a) has been also associated with non-cardiac vascular diseases and diseases associated with increased CV risk such as chronic kidney disease, metabolic syndrome, non-alcoholic fatty liver disease, erectile dysfunction, obstructive sleep apnea syndrome, inflammatory bowel diseases and human immunodeficiency virus infection. The above data are discussed in the present narrative review. Several guidelines suggest the clinical use of Lp(a) in (re)defining vascular risk, especially in asymptomatic individuals at intermediate or high CV risk and those with a family history of premature CHD. By improving individuals risk stratification, Lp(a) may contribute to a better secondary prevention strategy. However, there is still a need to establish a standardized method to measure Lp(a) as well as selective potent therapies for lowering Lp(a). This will support conducting large randomized trials in order to establish whether lowering circulating Lp(a) levels will result in a significant reduction in CV events.

Independent risk factors for severe cardiovascular events in male patients with gout: Results of a 7-year prospective study

To determine risk factors for severe cardiovascular (CV) events (CVEs) in male patients with crystal-verified gout. 251 male patients with crystal-verified gout were prospectively followed up in 2003 to 2013. The mean follow-up period was 6.9±2.0 years. New severe CVE cases and deaths were recorded. Logistic regression was used to analyze the impact of traditional and other risk factors and allopurinol use on the risk for severe CVEs. 32 patients died during the follow-up period. Severe CVEs were recorded in 58 (23.1%) patients; CVE deaths were notified in 22 (8.8%) patients. The risk of all severe CVEs was high for hypertension, increased serum high-sensitivity C-reactive protein (hs-CRP) level (>5 mg/l), ≥ stage III chronic kidney disease (CKD) (glomerular filtration rate, <60 ml/min/1.73 m2), alcohol intake (>20 g/day), coronary heart disease (CHD), and a family history of premature CHD. The risk of fatal CVEs was highest for elevated serum hs-CRP level, ≥ stage III CKD, a family history of premature CHD, hypercholesterolemia, upper quartile of serum uric acid levels (>552 µmol/l), and regular intake of allopurinol. In addition to the traditional risk factors of CV catastrophes, the presence of chronic inflammation and the impact of high serum uric acid levels may explain the high frequency of CV catastrophes.

Rapid Access Cardiology Clinics (RACC)–Assessing Cardiovascular Risk

Background: RACC, as part of the Western Sydney Integrated Care Programme (WSICP), was established as a hospital admission diversion strategy to manage low-intermediate risk chest pain. Our objective was to examine the cardiovascular (CV) risk factor burden of patients presenting to RACC. Methods: Clinical and lifestyle risk factor data were collected for consecutive patients presenting to RACC. Results: In the first 12 months, among 520 chest pain patients (55% male, mean age 55.2 years) assessed, 12% had pre-existing coronary heart disease (CHD) and 8% were diagnosed with new CHD. Among the 414 without CHD, 89(22%) were high CV risk according to a Framingham risk calculator, 43(10%) moderate, and 282(68%) low risk. At presentation 1.7% had chronic renal failure, 22% had HbA1c ≥ 6.5%, 70% had LDL-C ≥ 2 mmol/L, 32% had SBP ≥ 140 mmHg, 79% overweight (mean BMI 29.7 ≥ 6.7 kg/m2 and mean waist circumference was 101 cm), 33% had a family history of premature CHD, and 21% were current smokers or quit within the last 12 months. Also 81% exercised below Australian Heart Foundation guidelines, 82.3% ate less than the daily recommendations of vegetables, and 49% ate less than the daily recommendations of fruit each day. Overall 81% had 2 or more CV risk factors, and the mean number of CV risk factors (diabetes, smoker, hypercholesterolaemia, hypertension, family history, CRF, known CHD, elevated waist circumference) was 2.8. Conclusions: Many patients referred to RACC with chest pain have a high burden of uncontrolled risk factors. Thus, RACCs may bring new opportunities for modifiable risk factor optimisation and cardiovascular disease prevention.

Myocardial Infarction in the "Young": Risk Factors, Presentation, Management and Prognosis.

Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.

Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment.

Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease (CHD). Globally, one baby is born with FH every minute. If diagnosed and treated early in childhood, individuals with FH can have normal life expectancy. This consensus paper aims to improve awareness of the need for early detection and management of FH children. Familial hypercholesterolaemia is diagnosed either on phenotypic criteria, i.e. an elevated low-density lipoprotein cholesterol (LDL-C) level plus a family history of elevated LDL-C, premature coronary artery disease and/or genetic diagnosis, or positive genetic testing. Childhood is the optimal period for discrimination between FH and non-FH using LDL-C screening. An LDL-C ≥5 mmol/L (190 mg/dL), or an LDL-C ≥4 mmol/L (160 mg/dL) with family history of premature CHD and/or high baseline cholesterol in one parent, make the phenotypic diagnosis. If a parent has a genetic defect, the LDL-C cut-off for the child is ≥3.5 mmol/L (130 mg/dL). We recommend cascade screening of families using a combined phenotypic and genotypic strategy. In children, testing is recommended from age 5 years, or earlier if homozygous FH is suspected. A healthy lifestyle and statin treatment (from age 8 to 10 years) are the cornerstones of management of heterozygous FH. Target LDL-C is <3.5 mmol/L (130 mg/dL) if >10 years, or ideally 50% reduction from baseline if 8–10 years, especially with very high LDL-C, elevated lipoprotein(a), a family history of premature CHD or other cardiovascular risk factors, balanced against the long-term risk of treatment side effects. Identifying FH early and optimally lowering LDL-C over the lifespan reduces cumulative LDL-C burden and offers health and socioeconomic benefits. To drive policy change for timely detection and management, we call for further studies in the young. Increased awareness, early identification, and optimal treatment from childhood are critical to adding decades of healthy life for children and adolescents with FH.

Family history of premature cardiovascular disease: blood pressure control and long-term mortality outcomes in hypertensive patients

Current guidelines recommend early referral and initiation of intensive cardiovascular (CV) risk reduction in individuals with a positive family history of coronary heart disease (CHD). We hypothesized that a family history of premature CHD and stroke [CV disease (CVD)] would lead to earlier referral of hypertensive patients to secondary care clinic, leading to better control of risk factors, mitigating the excess risk seen in these individuals. We studied the association of a positive family history of CVD in 10 787 individuals with longitudinal changes in risk factors and long-term cause-specific mortality in the Glasgow Blood Pressure Clinic using generalized estimating equations and the Cox proportional hazard models, respectively. The total time at risk was 193 756 person-years with a median survival time of 29.2 years. A positive family history of CVD was associated with an earlier presentation to the clinic, a lower burden of traditional CV risk factors, and similar longitudinal blood pressure reduction and drug adherence compared with those without. But despite these positive features, all-cause [hazard ratio (HR) = 1.12, 95% confidence interval 1.01-1.25] and CV (HR = 1.20, 1.04-1.38) mortality independent of baseline risk factors were worse. Consistent results were observed in propensity score-matched analysis. Inclusion of family history of CVD did not improve mortality risk discrimination over and above traditional risk factors. Our study suggests that despite earlier referral and treatment of individuals with a positive family history of premature CVD, excess risk persists, indicating the need for continued and sustained efforts to reduce risk factors and drug adherence in these individuals.

Family history of coronary heart disease and the incidence and progression of coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA)

ObjectiveWe evaluated family history as a predictor of incident and progressive coronary artery calcium (CAC) using data from the Multi-Ethnic Study of Atherosclerosis (MESA). BackgroundMESA is a multi-center prospective study of 6814 asymptomatic individuals. The relationship between family history of coronary heart disease (CHD) and CAC incidence or progression has not been described previously. MethodsA total of 5099 participants had detailed information about family history of CHD (late versus premature and parental versus sibling history). The mean time between CAC scans was 3.1 ± 1.3 years. The association of late versus premature family history was assessed against CAC change using multivariate regression model adjusted for demographics and cardiac risk factors. ResultsA family history of premature CHD was associated with an odds ratio (OR) of 1.55 (p < 0.01) for incident development of CAC after adjusting for risk factors and demographics. A premature family history was associated with 14.4 units (p < 0.01) greater volume scores compared to those with no family history in similarly adjusted models by median regression analysis. A combined parental and sibling family history was associated with the greatest incidence and progression in demographic-adjusted models. Caucasians demonstrated the most consistent predictive relationship between family history of premature CHD and incidence (p < 0.01) and progression (p < 0.05) of CAC, though no significant interaction with ethnicity was noted. ConclusionsFamily history of premature CHD is associated with enhanced development and progression of subclinical disease, independent of other risk factors, in a multiethnic, population-based study.

Immune Activation and Coronary Atherosclerosis in HIV-Infected Women: Where Are We Now, and Where Will We Go Next?

Understanding the pathophysiology of coronary heart disease (CHD) in the human immunodeficiency virus (HIV)– infected population with access to antiretroviral therapy (ART) has become an important focus of recent research. CHD is, in fact, an emerging complication for individuals infected with HIV and presents a challenge for physicians involved in the care of HIV-infected patients. Cardiovascular disease is currently the third leading cause of death in HIV-infected individuals, after AIDS-related complications and malignancies. CHD is now the leading cardiovascular cause of death and morbidities, far more than heart failure, in HIV-infected patients on ART [1], whereas congestive heart failure related to immunocompromise is the leading cause of death in countries with poor access to ART [2].Many factors have been associated with myocardial infarction in the HIV population, ranging from traditional risk factors (eg, hypertension, tobacco use, dyslipidemia, diabetes, family history of premature CHD, microalbuminuria, and chronic renal failure) [3] to infection with hepatitis C virus [3], genetic factors [4], HIV itself [5], chronic inflammation [6], and immune activation [7]. Little is known about CHD in HIVinfected women. In several studies on acute coronary syndrome in HIV-infected patients, the proportion of women varied from 3% to 19% (mean, 10%) [1]. These figures are similar to those reported for HIV-uninfected women from the general population in a North American registry, where women aged <50 years accounted for <10% of cases of myocardial infarction [8]. The age distributions of HIV-infected and HIV-uninfected populations are, however, very different; those in the HIV-infected population are 10 to 15 years younger. Data from a North American epidemiological study have shown that the relative risk (RR) of myocardial infarction is higher in HIVinfected women than in uninfected female controls, with an RR of 2.98 [9]. Similarly, a French epidemiological study reported that the standardized morbidity ratio (SMR) was 2.7 for HIV-infected women vs uninfected female controls [10]. Of note, both the RR and the SMR were higher in HIV-infected women than in HIV-infected men (RR 1.4, SMR 1.4 [9, 10]). In the Women’s Interagency HIV Study (primary prevention study), 12% of HIV-infected women had a highly predicted 10-year risk of CHD, similar to that in the HIV-uninfected women; the mean age of the women was 40 years [11]. These data indicate that there are unmet needs in HIV-infected women at risk for CHD. How do we identify these women, how do we prevent an acute event, and what mechanisms are involved in their elevated risk of myocardial infarction? Fitch et al, in their article published in this issue of the Journal, focus on subclinical coronary atherosclerosis in HIVinfected women without symptoms or history of cardiovascular disease [12]. Using computed tomographic angiography (CTA), the authors report, for the first time, an increased prevalence of specific noncalcified coronary plaques and increased immune activation (monocyte activation) in asymptomatic HIV-infected women, when compared with female controls. These noncalcified plaques are potentially more prone to rupture than calcified plaques and, therefore, more likely to cause an acute coronary event. Fitch et al also found that age, HIV infection, and immune activation (particularly Received and accepted 1 August 2013; electronically published 16 September 2013. Correspondence: Franck Boccara, Department of Cardiology, Saint Antoine Hospital, Univ-Paris 6, AP-HP, 184 rue du Faubourg St Antoine, 75571 Paris Cedex 12, France (franck.boccara@ sat.aphp.fr). The Journal of Infectious Diseases 2013;208:1729–31 © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/infdis/jit511

How Accurate Are 3 Risk Prediction Models in US Women?

Cardiovascular disease (CVD) is the leading cause of death for US women, and nearly two thirds who died suddenly of CVD had no previous symptoms.1 Therefore, it is of great importance to identify “at-risk” women early, so that effective primary prevention strategies can be instituted. A universal recommendation of prevention guidelines is that all asymptomatic women should undergo a global risk assessment.2 Article see p 1748 The Adult Treatment Panel III (ATP-III) of the National Cholesterol Education Program set thresholds for lipid treatment based on one's predicted 10-year risk for a hard coronary heart disease (CHD) event (myocardial infarction or CHD death) using a modified Framingham risk score (FRS).3 There are limitations, however, with use of the ATP-III model for CVD prediction in women. The ATP-III version predicts “hard” CHD events but not angina or revascularizations, even if such revascularizations are performed to manage an acute coronary syndrome. Yet women are more likely to experience “soft” CHD events or strokes than men. Moreover, a single laboratory measurement does not reflect lipid values over a woman's lifetime. The FRS does not take into account family history of premature CHD, a well-established independent risk factor for CHD events.4 Also, because stroke accounts for a higher proportion of CVD events than CHD in women before age 75 years,1 we believe that total CVD risk should be the outcome for prediction and preventive strategies. Indeed, that is the conclusion of the 2011 American Heart Association CVD prevention guidelines for women.5 Furthermore, the FRS only predicts 10-year risk, whereas for women, the issue is most often “lifetime” risk. The Third National Health and Nutrition Examination Survey found that among women without a history of CHD or diabetes, 92% of those aged 60 to 69 years and >98% aged <59 …

What is the role of alternative biomarkers for coronary heart disease?

Predictive models for future risk of coronary heart disease (CHD) based on traditional risk factors, such as age, male gender, LDL cholesterol, HDL cholesterol, diabetes mellitus, hypertension, smoking and family history of premature CHD, are quite robust but leave room for further improvement. Thus, efforts are being made to assess additional biomarkers for CHD, such as, lipoprotein (a), C-reactive protein, fibrinogen, lipoprotein-associated phospholipase A2, homocysteine and others. However, none of the novel biomarkers has demonstrated improved prediction beyond traditional risk factor models in a consistent fashion across multiple cohorts. Many criteria have to be fulfilled before a biomarker can be considered clinically relevant. Another way is to develop new models predicting long-term or life-time risk of CHD. Further research using novel biomarkers and long-term predictive models has the potential to improve CHD risk prediction.

Family history of premature coronary heart disease and risk prediction in the EPIC-Norfolk prospective population study

ObjectiveThe value of a family history for coronary heart disease (CHD) in addition to established cardiovascular risk factors in predicting an individual's risk of CHD is unclear. In the European...

Providing Patients With Global Cardiovascular Risk Information

Providing Patients With Global Cardiovascular Risk Information

Comparative study of clinical characteristics between Chinese Han and German Caucasian patients with coronary heart disease

The differences of the clinical characteristics, risk factors, treatment and prognosis in coronary heart disease (CHD) patients from different races, area and countries are rarely reported. Collecting, comparing and analyzing the clinical data and blood examination results of 650 Chinese Han and 640 German Caucasian patients with CHD. The ratio of the first hospitalization because of CHD in Chinese patients was higher than that in Germans (95.1 vs. 38.1% P < 0.01). CHD occurred most frequently in elder men of both nations. The German CHD patients combined with hypertension, dyslipidemia and abnormal glucose metabolism were clearly more often than Chinese patients. Other risk factors such as fibrinogen, homocysteine and the proportion of positive family history of premature CHD, obesity, hyperuricemia were higher in German patients than that in Chinese patients. However, the ratio of smoking, acute myocardial infarction and the levels of high-sensitivity C-reactive protein in Chinese patients were obviously higher than that in Germans (P < 0.01, P < 0.05). The use of aspirin in both groups was the same, but the use of statins, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers were distinctly lower in Chinese patients compared to Germans (P < 0.01, P < 0.05). The proportion of percutaneous coronary intervention and coronary artery bypass grafting in Chinese patients was lower than that in Germans (P < 0.01). The usage of drug-eluting stents to bare-metal stents was slightly higher in German patients, whereas it was obviously higher in Chinese patients (P < 0.01). There were significant differences in clinical characteristics, risk factors and treatment of Chinese Han and German Caucasian patients with CHD.

Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth

Our understanding of the natural history of atherosclerosis in childhood and its response to cardiovascular (CV) risk factor reduction have been hampered by the lack of a reliable, non-invasive measure of atherosclerosis. Carotid intima media thickness (IMT), a surrogate marker of atherosclerosis in adults, is increased in youth heterozygous for familial hypercholesterolemia (FH) and declines with lipid lowering pharmacotherapy. The age at which vascular changes can be reliably identified using IMT and the influence of CV risk factors beyond FH on IMT remains unclear. ObjectiveTo examine the influence of demographic, family history, anthropometric characteristics and traditional CV risk factors on IMT in children 5–16 years of age (mean age 11 year). MethodsIn a cross-sectional study, we assessed IMT in 148 children (51 with elevated low density lipoprotein (LDL)-cholesterol, 44 with overweight and 53 controls). Measures included: family history of premature coronary heart disease (CHD), physical activity, pubertal stage, smoking history, fasting glucose, insulin, lipid profile, apolipoproteins A1 and B, anthropometry, blood pressure and IMT. ResultsThe groups were similar for age and family history of premature CHD. Compared to controls, average maximum IMT (0.403±0.04 vs 0.387±0.029) and average mean IMT were elevated in the hyperlipidemia group (p<0.05), but not in the overweight group (max IMT 0.393±0.034; p vs control=0.17). Using multiple regression modelling, age, family history of premature CHD and apoliprotein A1 and B predicted 17% of the variability in IMT. No measure of adiposity predicted IMT. ConclusionAge is an important predictor of IMT in youth. Among traditional CV risk factors, dyslipidemia and family history of premature CHD are independent predictors of IMT.

New recommendations for the diagnosis and treatment of plasma lipid abnormalities.

Elevated total blood cholesterol levels (at or above 240 mg/dL) due to increased low density lipoprotein (LDL) cholesterol values (at or above 160 mg/dL) have been associated with an increased risk of coronary heart disease (CHD). It has been shown in controlled prospective studies that when LDL cholesterol is lowered with diet or diet and drug treatment, subsequent risk of CHD morbidity and, in some cases, mortality can be reduced. New guidelines have recently been released by the Adult Treatment Panel (ATP II) of the National Cholesterol Education Program (NCEP). Risk factors for CHD in addition to elevated LDL cholesterol now include: 1) male 45 years or older; 2) female 55 or older, or with premature menopause and not on estrogen replacement; 3) high density lipoprotein (HDL) cholesterol less than 35 mg/dL; 4) hypertension; 5) cigarette smoking; 6) diabetes mellitus; and 7) a family history of premature CHD. After screening with total cholesterol and HDL cholesterol measurements, patients with total cholesterol values at or above 200 mg/dL, HDL cholesterol below 35 mg/dL, and/or CHD should have a fasting cholesterol, triglyceride, and HDL cholesterol measurement. Candidates for diet therapy are those with LDL cholesterol values at or above 1) 160 mg/dL; 2) 130 mg/dL in the presence of two or more CHD risk factors; or 3) 100 mg/dL in the presence of CHD. Candidates for drug therapy after diet treatment are those with LDL cholesterol values at or above 1) 190 mg/dL; 2) 160 mg/dL in the presence of two or more CHD risk factors; or 3) 130 mg/dL in the presence of CHD.(ABSTRACT TRUNCATED AT 250 WORDS)

National Cholesterol Education Panel ΙΙΙ Guidelines Performance Role in Preventing Myocardial Infarction in a Large Cohort Without a History of Coronary Artery Disease: Korea Acute Myocardial Infarction Registry Study

The Third Report of the Adult Treatment Panel National Cholesterol Education Program (NCEP-ATP III) guidelines are widely used for the primary prevention of a coronary event. These guidelines were developed using experimental data from studies that enrolled mostly Caucasian patients. The pathogenesis of atherosclerosis varies with ethnicity. Given these two circumstances, the authors sought to investigate the performance of the guidelines in a large Asian cohort. The Korea Acute Myocardial Infarction Registry (KAMIR) includes data collected between November 2005 and December 2006 from 41 referral centers in South Korea. A retrospective review of the clinical data was performed. After patients with a history of coronary heart disease (CHD), CHD equivalent, and those taking lipid-lowering medications were excluded, 2969 individuals (76% men; 61+/-12 years) were enrolled. The recommendations for lipid-lowering treatments according to the NCEP-ATP III were examined in the context of the cohort. A total of 38%, 66%, and 8% of the study participants had hypertension, were smokers, and had a family history of premature CHD, respectively. When patients were stratified by the number of risk factors present and their 10-year CHD risk, 69% diagnosed with an acute myocardial infarction did not qualify for drug therapy. Irrespective of the age group examined (young, intermediate, and old), the percentage of patients who did not qualify for a lipid-lowering pharmacologic intervention was higher than 60%. NCEP-ATP III underestimates CHD risk in individuals of Asian descent. Further studies are needed to improve primary CHD prevention in this patient population.

Prevalence of Emerging Cardiovascular Risk Factors in Younger Individuals with a Family History of Premature Coronary Heart Disease and Low Framingham Risk Score

The purpose of this study was to assess the prevalence of emerging cardiac risk factors in individuals with a family history of premature coronary heart disease (CHD) and who were predicted to be low-risk for cardiovascular (CV) disease based on their Framingham risk score. We prospectively evaluated 89 younger men and women with a family history of premature CHD and who had a low Framingham risk score. Patients with CHD or CHD equivalents were excluded. All patients were screened for emerging clinical and lipid risk factors. Coronary calcium was present in 38% of patients and C-reactive protein > 3 mg/dl was present in 24% of patients. Low levels of high-density lipoprotein (HDL2) cholesterol were the most prevalent emerging lipid risk factor and was present in 72% of the study group. More individuals had low levels of HDL2 than total HDL (34% versus 71%; p-value =0.001). Triglyceride- (TG)-rich remnant lipoproteins were present in 49% of patients. The Framingham risk score poorly predicts CV risk in younger healthy persons with a family history of premature CHD. The prevalence of subclinical CHD and emerging clinical and lipid risk factors is high in these patients. The most prevalent lipid risk factor was low levels of HDL2. Individuals with a family history of premature CHD may benefit from screening for emerging risk factors to better assess their CV risk.

Performance of the QRISK cardiovascular risk prediction algorithm in an independent UK sample of patients from general practice: a validation study

Aim:To assess the performance of the QRISK score for predicting cardiovascular disease (CVD) in an independent UK sample from general practice and compare with the Framingham score.Design:Prospective open cohort studySetting:UK...