Premature Family History Research Articles

Abstract P018: Overweight Is Not A Cardiovascular Risk Factor For Insulin-sensitive Individuals: CARDIA 30-year Follow Up

Introduction: Overweight and obeseare widely reported risk factors for atherosclerotic cardiovascular disease(ASCVD). However, their true impact ondisease risk may be complicated by interactions between measures of adiposityand insulin resistance. Hypothesis: Due to effect modification, the degree towhich overweight or obese increases ASCVD risk depends on fasting insulinstatus. Specific Aim: Determine the effects of overweight and obeseon incident ASCVD by estimating Cox hazard ratios for BMI categories, includingpotential interactions with fasting insulin. Methods: Cox proportional hazards regression models weredeveloped using 30-year follow up datafrom the Coronary Artery Risk Development in Young Adults (CARDIA) study. After excluding participants with baselinediabetes or cardiovascular disease, or those fasting <8 hours or pregnant, atotal of 4,555 subjects were analyzed. The primary outcome was incident ASCVD, defined as any fatal ornon-fatal MI, stroke, TIA, coronary revascularization, non-MI acute coronarysyndrome, CHF, carotid or peripheral artery disease. Cox models were developed, adjusting forcanonical ACC/AHA risk factors and the potential interaction between BMI and fastinginsulin. The reported effect size ishazard ratio (HR) with 95% confidence intervals (CI) and p-values. Results: Cox model 1 adjusted for family history ofpremature ASCVD, metabolic syndrome criteria, LDL-C >160 mg/dL, nicotine use(serum cotinine), chronic kidney disease (eGFR<60), history of earlymenopause, fitness level by treadmill, race, fasting insulin and BMI category. In model 1, both overweight (HR 1.46, 95% CI:1.07, 1.99; p=0.0158) and obese (HR 2.21, 95% CI: 1.52, 3.21; p<0.0001) appearedto be independently associated with incident ASCVD. Cox model 2 included an interacting categoricalvariable that included both BMI andfasting insulin. In model 2, overweightwas not a risk factor for CARDIA participants with fasting insulin values inthe lower half (<9.0 μIU/mL): HR 1.36, 95% CI: 0.81,2.30, p=0.2482. However, overweight wasa significant risk factor for those with fasting insulin in the upperhalf: HR 2.21, 95% CI: 1.51, 3.24, p<0.0001. This result was cross-checked and confirmed using otherwise identical modelsstratified by fasting insulin level. Thehazard ratios were 1.34 (95% CI: 0.79, 2.27, p=0.2818) for normoinsulinemic,overweight individuals and 1.51 (95% CI 1.03, 2.21, p=0.0367) forhyperinsulinemic, overweight individuals, as compared with those with BMI<25. In contrast to overweight, obese was anindependent risk factor for ASCVD regardless of fasting insulin status. Conclusion: Overweight was not an ASCVD risk factor forCARDIA participants with low fasting insulin. If confirmed, these findings could inform tailored weight-lossrecommendations for overweight individuals.

Abstract WMP102: Prevalence Of Genetic Mutations In 15 Mendelian Stroke Genes In Young Stroke Patients

Introduction: Although the heritability of stroke might be higher in young-age stroke population, it is even uncertain how many of them has monogenic causes of stroke. We aimed to estimate the prevalence and clinical characteristics of 15 monogenic disorders associated with stroke in a large, unselected young-age stroke population Methods: From a prospective, nationwide, multicenter, acute stroke registry of consecutive patients admitted to 15 academic or regional stroke centers in Korea, we enrolled all patients aged 55 years or younger except those who refuse to participate in this study. We performed genetic analysis using a customized targeted next-generation sequencing panel ( GLA, NOTCH3, HTRA1, RNF213, ACVRL1, ENG, CBS, TREX1, ABCC6, COL4A1, FBN1, NF1, COL3A1, MT-TL1, and APP ) to find clinically relevant genetic variants, and reviewed clinical information of the patients. Results: Genetic analysis was performed in 1,033 patients (male 70.7%, mean age 45.8±7.9). Twenty-eight clinically relevant genetic variants were identified in 131 (12.7%) patients, and were found most frequently in RNF213 (59, 5.7%) followed by ABCC6 (53, 5.1%) and NOTCH3 (15, 1.5%). Genetic variants were more commonly observed in younger group than older group (17.1% vs. 9.3%, p=0.021), but were not different according to vascular risk factor burden. Patients with premature (<60y) family history of stroke had genetic variants more frequently than those with family history at ≥60y (23.7% vs. 11.4%, p=0.047). Typical neuroimaging abnormalities were observed in only 25% of patients with RNF213 variants and 27% of those with NOTCH3 variants. Variants of uncertain significance were found in 15.4%. Conclusion: Clinically relevant genetic variants were not uncommon than expected. We might have opportunities to improve our daily practice by genetic counseling patients and their families to reduce the future stroke.

Significant Coronary Artery Disease in Patients Undergoing Valve Replacement Surgery

Objective: To determine the frequency of angiographically significant coronary artery disease (CAD) in patients undergoing valve replacement surgery and referred for Coronary angiography. Study Design: Cross Sectional Descriptive Study. Study Setting& duration: From 14th February 2016 to 14th August 2016 in the Department of Cardiology, Tabba Heart Institute, Karachi. Material and Methods: Total 127 patients of both genders with age 40-75 years undergone referred for coronary angiography and as a pre requisite of required valve replacement surgery were included and significant findings were noted. The history of comorbid, family history of premature CAD, smoking and basal metabolic index were noted. Results: There were 58.3% male and 41.7% female patients. Average age was 54.60±8.91 years. Mean BMI was 28.64±4.62 Kg/m2. 75.6% patients were obese. Angiographically significant CAD was observed positive in 27.6% patients. Significant association was found with hypertension and premature family history of CAD. The prevalence was high in patients with MVR followed in patients with AVR. Conclusion: The overall prevalence of angiographically significant coronary artery disease was 27.6%.in cases going through valve replacement is substantial. The prevalence was high in patients with MVR followed in patients with AVR. Keywords: CAD, Angiography, Significant Coronary Artery Disease, Valve Replacement Surgery

Long-Term Prognostic Implications and Role of Further Testing in Adults Aged ≤55 Years With a Coronary Calcium Score of Zero (from the Multi-Ethnic Study of Atherosclerosis)

The long-term prognostic significance of a coronary artery calcium (CAC) score of 0 is poorly defined in younger adults. We evaluated this among participants aged 45 to 55years from the Multi-Ethnic Study of Atherosclerosis, and assessed whether additional biomarkers can identify subgroups at increased absolute risk. We included 1,407 participants (61% women) without diabetes or severe hypercholesterolemia, with estimated 10-year risk <20% and CAC=0. We evaluated all and hard cardiovascular disease (CVD) events, overall and among subjects with each of the following: high-sensitivity C-reactive protein levels ≥2mg/L, homocysteine ≥10µmol/L, high-sensitivity cardiac troponin T ≥95th percentile, lipoprotein (a) >50mg/dl, triglycerides ≥175mg/dl, apolipoprotein B ≥130mg/dl, albuminuria, thoracic aortic calcium, aortic valve calcium (AVC), mitral annular calcium, ankle-brachial index <0.9, any carotid plaque, and maximum internal carotid artery intima-media thickness (ICA-IMT) ≥1.5mm. Median follow-up was 16years, and overall CVD event rates were low (4% at 15years). For most exposures evaluated, rates of all CVD events were <6 per 1,000 person-years, except for ICA-IMT ≥1.5mm (6.43) and AVC (13.8). The number needed to screen to detect ICA-IMT ≥1.5mm was 8, and 84 for AVC. Among participants with borderline/intermediate risk or premature family history, hard CVD event rates were <7 per 1,000 for most exposures, except for ICA-IMT ≥1.5mm (8.25), albuminuria (8.30), and AVC (13.47). Nonsmokers and those with ICA-IMT <1.5mm had very low rates. In conclusion, our results demonstrate a favorable long-term prognosis of CAC=0 among adults aged ≤55 years, particularly among nonsmokers. ICA-IMT testing could be considered for further risk assessment in adults ≤55years with CAC=0 and uncertain management.

Does management of lipid lowering differ between specialists and primary care: Insights from GOAL Canada.

We studied whether significant differences in care gaps exist between specialists and primary care physicians (PCPs). GOAL Canada enrolled patients with CVD or familial hypercholesterolemia (FH) and LDL-C>2.0mmol/L despite maximally tolerated statin therapy. During follow-up, physicians received online reminders of treatment recommendations based on Canadian Guidelines. A total of 177 physicians (58% PCPs) enrolled 2009 patients; approximately half of the patients were enrolled by each physician group. Patients enrolled by specialists were slightly older (mean age 63years vs 62), female (45% vs 40%), Caucasian (77% vs 65%), and had a slightly higher systolic pressure and lower heart rate. Patients enrolled by specialists had less frequent history of FH, diabetes, hypertension, chronic kidney disease and liver disease but more frequent history of coronary artery disease, atrial fibrillation and premature family history of CVD. There was no significant baseline difference in LDL-C, HDL-C or non-HDL-C, although total cholesterol and triglycerides were slightly higher in patients managed by PCPs. At baseline, PCPs were more likely to use statins (80% vs 73%, P=.0002) and other therapies such as niacin or fibrate (10% vs 6%, P=.0006) but similar use of ezetimibe (24% vs 27%, P=.15). At the end of follow-up, specialists used less statins (70% vs 77%, P=.0005) and other therapies (6% vs 10%, P=.007) but more ezetimibe (45% vs 38%, P=.01) and the same frequency of PCSK9i (28% vs 27%, P=.65). The proportion of patients achieving the recommended LDL-C level of 2.0mmol/L or below (primary endpoint) was similar at last available visit between specialists and PCPs (44% vs 42%, P=.32). Despite minor differences in the clinical profile of their patients, both PCPs and specialists actively participate in the management of lipid-lowering therapy in high-risk CVD patients and experience similar challenges and care gaps.

Risk Factors Analysis of Premature Canities in Medical Students of Universitas Sumatera Utara Class 2016-2018

Abstract. Background. Premature canities is a terminology to describe a premature graying of hair before the age of 25 in Asians.The ethiopathogenesis of premature canities is still not fully understood, but there are risk factors associated to premature canities such as gender, family history, obesity, smoking, alcohol consumption, other disease, micronutrients deficiencies. Aims: to evaluate risk factors that influence the incidence of premature canities in medical students of University of Sumatera Utara class 2016-2018. Methods: This research is an analytic research with the number of subjects are 80 respondents using bivariate and multivariate analysis using logistic regression test. Results: of the 80 respondents, 57 respondents (71,2%) had premature canities. Based on bivariate analysis, it was obtained p value ≤ 0,05 for family history and stress, Based on multiavariate analysis, it was obtained p value ≤ 0,05 for family history (p value = 0,000), which means family history is the most dominants factors for premature canities. Conclusion: there is a correlation between premature canities and family history and stress and Family history is the most dominant risk factors that associated to premature canities in medical students of University of Sumatera Utara class 2016-2018.

A modified algorithm with lipoprotein(a) added for diagnosis of familial hypercholesterolemia.

BackgroundPrevious studies have observed that high level of lipoprotein (a) [Lp(a)] was common in the phenotypic familial hypercholesterolemia (FH) and may explain part of the clinical diagnosis of FH.HypothesisWe aim to develop a modified model including Lp(a) and compare its diagnostic performance with Dutch Lipid Clinic Network (DLCN) criteria.MethodsData of 10 449 individuals were utilized for the model establishment (7806 for derivation and 2643 for validation) from January 2011 to March 2018. The novel score model was modified on the basis of DLCN. Furthermore, 718 patients were screened for LDLR, APOB, and PCSK9 gene mutations.ResultsThe novel modified model consisted of untreated low‐density lipoprotein cholesterol (LDL‐C) level, Lp(a), personal premature coronary heart disease (CHD), tendon xanthomas and family history of CHD and/or hypercholesterolemia. It has shown high discrimination (area under curve [AUC] 0.991, 95% confidence interval [CI[ 0.988‐0.994, P < .001) for distinguishing clinical FH from non‐FH diagnosed using DLCN. Furthermore, a concordance analysis was performed to compare the modified model with DLCN and it showed a good agreement with DLCN (κ = 0.765). External validation of the novel model also showed good accordance (κ = 0.700). Further genetic analysis showed that the agreements between the new model and mutation improved a little compared to that between DLCN and mutation.ConclusionsThe novel modified model, including Lp(a), could provide new insights into FH diagnosis in Chinese population with more concerns on the patients with high level of Lp(a).

Spotlight from the American Society for Preventive Cardiology on Key Features of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol.

The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol retains focus on recommendations for statin treatment in the original four statin-eligible groups [those with atherosclerotic cardiovascular disease (ASCVD), diabetes, low-density lipoprotein cholesterol (LDL-C) ≥ 190mg/dL, and higher risk primary prevention] without the use of treatment initiation or target LDL-C levels from the earlier 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline, but has several new features. First, patients with primary prevention are divided into those who are at low (< 5%), borderline (5% to < 7.5%), intermediate (7.5% to < 20%), and high (≥ 20%) risk based on the ASCVD risk estimator. Moreover, the new guideline goes further to consider a wider range of factors [now called "risk enhancers"-premature family history of ASCVD, persistently high LDL-C, chronic kidney disease (CKD), metabolic syndrome, conditions specific to women, inflammatory diseases, and high-risk ethnicities] that can be used to better inform the treatment decision. Moreover, more detailed recommendations on how the results of coronary calcium scanning can be used to inform the treatment decision are provided, including how it may be used to "de-risk" certain patients for delaying or avoiding the use of statin therapy. There are also specific sections for cholesterol management in other patient subgroups including women, children, certain ethnic groups, those with CKD, chronic inflammatory disorders and HIV, as well as discussion on the management of hypertriglyceridemia. Importantly, for persons with known ASCVD, a distinction is made for those who are at "very high risk" based on having had two major ASCVD events or one major event and two or more other high risk conditions, such as diabetes or other major risk factors, or bypass surgery or percutaneous intervention. Finally, the concept of a threshold LDL-C for initiating a non-statin therapy (after considering highest tolerated statin dosage) is provided, with ezetimibe recommended as the key non-statin to be added if the LDL-C still remains ≥ 70mg/dL for all ASCVD patients, and in those who are at "very high risk", further consideration for using a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. While the new guideline does have greater detail (and arguably, complexity), the refinements provide a strategy for guiding the clinician to target both statin and non-statin therapy to those most likely to derive benefit.

Abstract 11807: Phenotyping Family History of Coronary Heart Disease to Inform Risk Assessment for Cardiovascular Events in MESA

Introduction: The relationships between various family history (FH) of coronary heart disease (CHD) phenotypes and cardiovascular disease (CVD) events have not been fully explored. Hypothesis: The association between FH and CVD will differ by, 1) FH at any age vs. premature FH in a parent, sibling, or child, and 2) familial risk score strata (weak, moderate, or strong; see Table for details). Methods: We ascertained CVD events (CHD, angina, stroke, peripheral arterial disease [PAD], and heart failure [HF]) over a median of 10.1 years. Multivariable Cox models examined the association of FH with CVD events (individual and composite). The C-statistic assessed the prognostic impact of FH for predicting CVD when added to traditional RFs. Results: Of 6192 adults [mean (±SD) age 62±10 years, 48% men, 40% white] with information on FH, 36% reported any FH. Those with strong familial risk (n=1240) were more likely to be diabetic, overweight, smoke, or take medication for hypertension and dyslipidemia. Overall, 741 CVD events occurred. Compared to no FH, any FH was associated with incident CHD, angina, and composite CVD in adjusted models [hazard ratio (95% CI)]: 1.4 (1.1-1.8), 1.6 (1.2-2.1), and 1.3 (1.1-1.5), respectively]. Nearly identical results were obtained for premature FH ( Table ). Compared to weak familial risk, strong risk was also associated with CHD, angina and CVD. However, there was no association between FH of any type and stroke, PAD, or HF. FH status (any or premature) and familial risk score improved discrimination of CVD (p =0.0005, p=0.005, and p=0.001, respectively). Familial risk score provided marginal discrimination over and above premature FH status (C statistic from 0.742 to 0.744, p=0.051). Conclusion: The association between FH and CVD risk differs depending on the number of affected family members, suggesting the value of detailed FH information to refine risk assessment. The predictive value of FH of CHD for non-coronary events is limited.

Comparison of Carotid Intima Media Thickness in Children of Patients with and without Premature Coronary Artery Disease.

Increased Carotid Intima Medial Thickness (CIMT) is associated with cardiovascular risk factors and vascular events like Coronary Artery Disease (CAD) and stroke. This study was designed to identify whether CIMT is increased in the children of parents with premature coronary artery disease and compare it with age and sex matched controls who are children of normal individuals. We also tried to compare and correlate the changes in CIMT if any, among the study group with relation to family history of diabetes and hypertension. It was an observational prospective case control study. Twenty five cases (children of parents with premature coronary artery disease) were recruited as per the inclusion and exclusion criteria. Age and sex matched controls were recruited from the paediatric Outpatient Department (OPD). The CIMT was measured using ultrasound Doppler as per the protocol by the Mannheim intima media thickness consensus statement. Ten children out of 25 controls had CIMT of 0.05 cm and 5 out of 25 cases had CIMT of 0.07 cm. The association between cases and controls was not statistically significant. Even though the CIMT increases after 10 years, there is no statistically significant association between cases and controls in the different age groups. Out of the total 48% of the children among the case group had family history of hypertension whereas 28% in the control group. A 33% of children in the case group with family history of hypertension had CIMT of 0.07 cm; 46% of children in case group without family history of hypertension had CIMT of 0.05 cm. This difference was statistically significant (p=0.005). There was no significant association between family history of diabetes mellitus and CIMT in both groups. There was significant association between CIMT in children with family history of premature CAD and family history of hypertension when compared with no family history of hypertension with premature CAD. There was no significant association between CIMT of children with and without family history of premature CAD.

Prevalance of cardiovascular risk factors according to gender

Objective : To compare prevalence of major risk factors for heart diseases among males and females admitted at Karachi Institute of Heart Diseases (KIHD), Karachi. Methods : This was a Cross sectional, Descriptive study conducted at KIHD, during June 2010 – September 2010. Total 302 patients were included in study by Convenient Sampling Technique. Patients of known Cardio Vascular Diseases [CVDs] admitted in general or private wards of KIHD were recruited regardless of any age, gender or race. After taking informed consent patients were asked in their mother tongue about different risk factors of CVDs like Hypertension, Diabetes, Family history of premature [<50 years] Coronary Artery Disease [CAD], Smoking, Smokeless tobacco, Prior history of Coronary Heart Failure [CHF] or Myocardial Infarction [MI], Renal failure and Chronic Lung Disease [CLD]. All data was entered and analysed thorough SPSS v 16. Results : A total of 302 patients were observed among them 150 (49.7%) were males and 152(50.3%) females. Mean age and (±SD) for male and female was 55.97 (±10.84) and 56.15(±12.04) respectively. Hypertension (77.6%, P <0.001), Diabetes Mellitus (48%, P 0.007), and CLD (13.2%, P 0.002) were more prevalent in females, whereas cigarette smoking (44%, P <0.001) was more prevalent in males. The prevalence of angina pectoris was significantly higher in both genders as it was found in 83(55.3%) males and 91(59.9%) females (p 0.425), but unstable angina was more common in females 56(36.8%) and stable angina 48(32%) in males (p 0.028). About 68(45.3%) males had an episode of Myocardial Infarction (MI) in contrast to 49(32.24%) females (p 0.019), which showed that male gender has higher rate of MI incidence. No considerable difference was found for family history of CAD, consanguine marriages, prior history of CHF and renal failure. Conclusion : Hypertension was most prevalent risk factor in both genders but predominantly affect females challenging pre existing beliefs. Therefore measures should be taken to increase awareness of CVD in both males and females.

Clinical and prognostic correlates of ST-elevation myocardial infarction patients with normal coronary angiography

Background: Revascularization within a 90-min door-to-balloon time is a strict policy enacted in Taiwan. Prompt diagnosis is critical to avoid an unnecessary procedure and catheterization laboratory activation. This study was aimed to investigate the clinical and prognostic characteristics of the patients with ST-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI) and normal coronary arteries found following coronary angiography (CAG). Materials and Methods: From October 2009 to December 2012, 216 consecutive patients with STEMI referred for primary PCI were enrolled. The data of clinical history, physical examination, laboratory results, electrocardiography, echocardiography, CAG findings, diagnosis, and outcomes were collected and analyzed. Results: A total of 17 patients were proved normal coronaries angiographically. The incidence of the conditions mimicking as STEMI is 7.9%. Alternative diagnosis was coronary spasm ( n = 7), peri-myocarditis ( n = 6), apical ballooning syndrome ( n = 3), anaphylactic shock ( n = 1). Compared with STEMI group, patients in normal coronaries group were younger, with a less premature family history of coronary artery disease (CAD), and reported angina. The 30-day mortality rate in the normal coronaries group was 5.9%. Conclusions: Cautiously evaluating CAD risk factors and symptoms of angina and awareness of alternative diagnosis are important to make a prompt diagnosis without compromising accuracy in the patients presenting as suspected STEMI.

Diabetic cardiomyopathy in medical examination patients with impaired glucose tolerance and Type 2 diabetes

To investigate the change of diabetic cardiomyopathy in patients with impaired glucose tolerance (IGT) and Type 2 diabetes (T2DM) and its influencing factors. Patients with IGT and T2DM were divided into an IGT group (n=314), a T2DM group (n=368) and an NC group (400 normal subjects). The left ventricular ejection fractions (LVEF) and the interventricular septal depth (IVSd) were measured by Doppler echocardiography. The general information and blood biochemistry were also collected during the corresponding time period. Compared with the NC group, waist circumference (WC), bodymass index (BMI), premature family history of cardiovascular disease, the serum levels of fasting plasma glucose (FPG), HbA1c, TC, TG, hyperlipidemia, BUN and Cr significantly increased (P<0.01) in the IGT and T2DM groups. Compared with the NC group and the IGT group, the LVEF significantly decreased (P<0.01) and the IVSd significantly increased (P<0.01) in the T2DM group. The LVEF and IVSd did not have obvious difference between the NC group and the IGT group. Pearson correlation analysis showed a negative correlation between LVEF and HbA1c, TC and duration of disease (P<0.01); but a positive correlation between IVSd and WC, BMI, HbA1c and duration of disease, and a negative correlation between IVSd and HDL (P<0.05). In the multiple linear stepwise regression, HbA1c and duration of disease showed a significant association with both LVEF and IVSd (P<0.05). T2DM has a close association with cardiomyopathy. HbA1c and duration of disease are the independent predictors for LVEF and IVSd.

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.

The epidemic of pediatric chronic kidney disease: the danger of skepticism

The epidemic of pediatric chronic kidney disease: the danger of skepticism

Association Between Family History and Coronary Heart Disease Death Across Long-Term Follow-Up in Men

Background— Family history of coronary heart disease (CHD) has been well studied as an independent risk factor for CHD events in the short term (&lt;10 years). However, data are sparse on the association between family history and risk for CHD across long-term follow-up. Methods and Results— We included 49 255 men from the Cooper Center Longitudinal Study. Premature family history of CHD was defined as the presence of angina, myocardial infarction, angioplasty, or bypass surgery in a relative &lt;50 years of age. Cause-specific mortality was obtained from the National Death Index. The association between premature family history and cardiovascular disease (CVD) or CHD death was compared across 3 unique follow-up periods (0–10, &gt;10–20, and &gt;20 years). Lifetime risk was estimated by use of a modified survival analytic technique adjusted for competing risk with non-CVD death as the competing event. After 811 708 person-years of follow-up, there were 919 CHD deaths and 1456 CVD deaths. After adjustment for traditional risk factors, premature family history was associated with CHD mortality &gt;10 to 20 years (1.59; 95% confidence interval, 1.14–2.22) and &gt;20 years (1.43; 95% confidence interval, 1.05–1.95) with wider confidence intervals at 0 to 10 years (1.32; 95% confidence interval, 0.76–2.31). Similar findings were observed for CVD mortality. Compared with men without a family history of coronary artery disease, premature family history was associated with an ≈50% higher lifetime risk for both CHD and CVD mortality (13.7% versus 8.9% and 21% versus 14.1%, respectively). Conclusion— Premature family history was associated with a persistent increase in both CHD and CVD mortality risk across long-term follow-up, resulting in significantly higher lifetime risk estimates.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

SP1-84 Different methods to calculate population attributable fraction of risk factors for cardiovascular diseases: Tehran lipid and glucose study (TLGS)

BackgroundThe population attributable fraction (PAF) that estimates potentially community-level effect of risk factors can be useful in planning public health interventions. This study compared different methods for calculating adjusted PAFs...

Clinical Characteristics, Vascular Function, and Inflammation in Women With Angina in the Absence of Coronary Atherosclerosis: The Dallas Heart Study

we sought to evaluate the relationship between angina and coronary artery calcium (CAC) in women, and among women without CAC, the associations between angina and clinical, vascular, and inflammatory factors. angina in women without coronary atherosclerosis is associated with significant morbidity, yet its determinants are poorly understood. women ages 30 to 65 years from the Dallas Heart Study, a multiethnic probability sample of Dallas County residents, who completed a Rose angina questionnaire and had complete data for CAC by computed tomography were selected for this analysis. Soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, high sensitivity C-reactive protein, monocyte chemoattractant protein-1 and aortic compliance by magnetic resonance imaging were measured. among the 1,480 women in this cohort (mean age 45 years, 49% African-American), angina was present in 6.9% but was not associated with CAC (19% CAC prevalence with angina vs. 15% without, p = 0.2). Among women without CAC, angina was related to variables reflecting obesity and insulin resistance and was independently associated with African-American ethnicity, premature family history of myocardial infarction, and waist circumference (all p < 0.05). Such women with angina also had higher levels of soluble intercellular adhesion molecule-1 (668 vs. 592 ng/ml, p = 0.02) and soluble vascular cell adhesion molecule-1 (1,106 vs. 968 ng/ml, p = 0.01) and reduced aortic compliance (mean 22 vs. 26 ml/mm Hg, p = 0.007) than such women without angina. Conversely, there was no difference in C-reactive protein or monocyte chemoattractant protein-1 levels for women with and without angina (p = not significant, each). angina among women in the general population is common and is not associated with subclinical atherosclerosis. Additionally, angina in the absence of subclinical atherosclerosis is not related to many traditional atherosclerotic risk factors but is associated with clinical, inflammatory, and vascular factors that reflect endothelial dysfunction and vascular stiffness, suggesting a distinct vascular etiology and alternative potential therapeutic targets.

Family history of premature coronary heart disease: Discussing the evidence

People with a premature family history of coronary heart disease have an increased cardiovascular risk. The National Service Framework for Coronary Heart Disease, and the current Joint British Societies Guidelines both stipulate that these people should be targeted for preventative health care measures. This article discusses the key studies associated with a positive premature family history of coronary heart disease. The historical evidence that supports the theory that family history is an independent risk factor for coronary heart disease are presented. The mechanism for this risk factor is explored and the preventive studies that have been conducted to address the problem are identified. The implications of the findings of these studies, on a population and individual level, are discussed.