P3412Risk factors, biomarkers and framingham risk estimate fail to identify presence of subclinical atherosclerosis in young individual with family history of premature coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ghadiri ◽  
J Leipsic ◽  
N Elahi ◽  
M Anastasius ◽  
A Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Subclinical Atherosclerosis ◽  
Calcium Score ◽  
Premature Coronary Artery Disease ◽  
Framingham Risk ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease

Abstract Introduction Patients with family history of premature coronary artery disease (CAD) are at increased risk of CAD events at a younger age. Risk factor based approaches and clinical evaluation are most commonly used to assess these individuals. However, it has been recently shown that up to 50% of individual presenting with their first myocardial infarction (MI) were considered to be “low risk” prior to that event. MI is often a result of plaque rupture preceded by progression of subclinical atherosclerosis. Detection of subclinical atherosclerosis may therefore help target prevention of plaque progression. We assessed the value of clinical risk factor, biomarkers and Framingham Risk Score (FRS) in predicting subclinical atherosclerosis in individuals with a family history of premature CAD. Methods From 310 referrals, 222 individuals between the ages of 35 and 55 with a family history of premature CAD (CAD events in first-degree family members (male <55, female <65)) were enrolled for evaluation of risk of CAD. Those with familial hypercholesteremia (possible, probable or definite) were excluded. Patients underwent clinical and risk factor evaluations as well as Cardiac CT or Calcium Score (CS) to assess presence of subclinical / clinical atherosclerosis at the discretion of the treating physician. Results In this pilot, 141 individuals (59% male, mean age 45.9±6.0 years) completed evaluation, and 65 (46%) had evidence of subclinical atherosclerosis on CT coronary angiography or CT calcium score with a mean segment involvement score (SIS) of 2.8 and mean CS of 152, putting them above the 80th percentile for their age and sex. Aside from male sex, age, and smoking history, other traditional risk factors and biomarkers including diabetes mellitus, hypertension, total cholesterol, LDL-C, HDL-C and Cholesterol/HDL-C were not significantly different between those with or without subclinical atherosclerosis (Table 1). Table 1 Conclusion In young individuals with a family history of premature CAD, risk factors, biomarkers, and FRS failed to identify individuals with premature, subclinical atherosclerosis in this pilot study. Detection of subclinical atherosclerosis and early implementation of treatment with the aim of stabilizing plaques and stopping progression might prove vital in reducing events in these individuals. Further studies are warranted.

P3432Coronary artery calcium score is of limited sensitivity in detecting subclinical atherosclerosis in young individuals with family history of coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Huang ◽  
A Mugharbil ◽  
M Anastasius ◽  
S Ghadiri ◽  
J Leipsic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Family History ◽  
Subclinical Atherosclerosis ◽  
Age Groups ◽  
Calcium Score ◽  
Atherosclerotic Plaques ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease ◽  
Limited Sensitivity

Abstract Introduction Family history of premature coronary artery disease (CAD) is known to predispose individuals to adverse CAD events, often at a younger age. Current risk stratification strategy is suboptimal, as up to 50% of individuals were considered “low-risk” prior to their first presentation of myocardial infarction. Coronary artery calcium score (CACS) is a marker of atherosclerosis and provides incremental value in risk stratification. However, the utility of CACS may be limited in younger patients as they often have non-calcified atherosclerotic plaques. In this study, we evaluate the sensitivity of CACS in detecting subclinical atherosclerosis in different age groups. Method From 310 referrals to a specialized unit in the management of early atherosclerosis, 222 individuals with a family history of premature CAD (defined as CAD events in first-degree family members, male<55 and female<65) and aged between 35 and 55 were enrolled for assessment of their CAD risks. Individuals with possible, probably or definite familial hypercholesterolemia were excluded. In addition to clinical and risk factor evaluation, cardiac CT and CACS were performed in select individuals, at the discretion of the treating physician. Results Of the 141 (59% male, mean age 45.9±6.0 year) individuals that completed clinical evaluation, 65 (73% male, mean age 47.4±6.9 years) have subclinical atherosclerosis (defined by the presence of atherosclerotic plaques in any of the coronary artery segments in cardiac CT). Of them, 52 have CACS>0, giving an overall sensitivity of 80%. The breakdown by age group is shown in table 1. The sensitivity of CACS in detecting subclinical atherosclerosis is quite modest in younger individuals (60% in individuals <45 year-old) but improves with patient age (>85% in >45 years). Table 1. Sensitivity of CACS in different age groups Age group True Positive Fast Negative Sensitivity N (CAC+ CTCA+) (CAC+ CTCA−) (%) <40 6 4 60 10 41–45 7 4 55 11 46–50 19 3 86 22 51–55 20 1 95 21 Conclusion In younger individuals (<45 years) with family history of premature CAD, CACS is of limited sensitivity in detecting subclinical atherosclerosis, and should not be used to rule out CAD. Further studies are warranted.

Risk Factors for Coronary Artery Disease in Patients Undergoing Coronary Angiogram at a Tertiary Level Hospital in Nepal

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Jeetendra Mishra ◽  
Achutanand Lal Karn ◽  
Alok Kumar Singh ◽  
Asraf Hussain ◽  
Ramji Ram ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Family History ◽  
Coronary Arteries ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease

Background: Ischemic heart disease is the leading cause of CVD health loss globally, as well as in each world region, followed by stroke.  In Nepal, CVD was found to be the second most common non-communicable disease among indoor patients of the non-specialist hospital. Age, gender, smoking, obesity, dyslipidemia, physical inactivity, hypertension, and diabetes mellitus (DM) are established risk factors for CVD.  In Nepal, hypertension is found to be the most prevalent risk factor for CVD. Aims and Objectives: This study aimed to assess risk factors for coronary artery disease in patients undergoing coronary angiograms in Nepal. This study also investigated the socio-demographic characteristics of the participants and the nature of the involvement of coronary arteries. Materials and Methods: We examined in this cross-sectional study a total of 74 patients who underwent coronary angiography (CAG) at National Medical College between May 2020 and June 2021. Patients were grouped according to the number of major epicardial coronary arteries involved in SVD, DVD, and TVD. Patients were checked for risk factors like smoking, diabetes mellitus, hypertension, dyslipidemia, family history of coronary artery disease, and obesity. Microsoft Office Excel and SPSS version 21.0 were used for data analysis. The study was approved by the ethical committee. Results: Among 74 participants 53 were male. The mean age was 59.65±10.74 years. Premature coronary artery disease was present in six patients. SVD was the commonest CAD type. Hypertension was the commonest risk factor followed by Diabetes mellitus. Hypertension, Diabetes mellitus, Family history of premature CAD, and obesity were found to be statistically significant. Keywords: CAD, Risk factors for CAD, Premature CAD, Hypertension, Diabetes, obesity, family history of CAD, dyslipidemia, Smoking, SVD, DVD, TVD, Nepal

scholarly journals Risk factors for atherosclerosis in children and adolescents with family history of premature coronary artery disease

10.2223/1153 ◽  
2004 ◽  
Vol 80 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Ceres C. Romaldini ◽  
Hugo Issler ◽  
Ary L. Cardoso ◽  
Jayme Diament ◽  
Neusa Forti
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Children And Adolescents ◽  
Premature Coronary Artery Disease ◽  
History Of ◽  
Artery Disease

scholarly journals Screening for Premature Coronary Artery Disease (CAD) using Coronary Artery Calcium (CAC) Score: A Primary Prevention Pilot Study

2021 ◽  
Vol 16 (1) ◽  
pp. 134-149
Author(s):  
Hamat Hamdi Che Hassan ◽  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Primary Prevention ◽  
Coronary Artery Calcium ◽  
Overweight And Obesity ◽  
Premature Coronary Artery Disease ◽  
History Of ◽  
Artery Disease

Acute Coronary Syndrome (ACS) events can be accelerated by positive family history of young coronary artery disease (CAD). Risk factors assessment sometimes fail to predict ACS occurrence. Additional investigations with coronary artery calcium (CAC) score can be used independently in screening for primary prevention in some population. This was a cross-sectional study in asymptomatic population with first degree relatives (FDR) having premature CAD compared with a matched population with no family history of CAD from September 2017 to March 2018 at the Cardiology Clinic of Univeristi Kebangsaan Malaysia Medical Centre. A total of 36 subjects were recruited with equal number in each group. Female were the majority in each group (66.7%). The FDR group were slightly younger compared to the control group [mean (SD) age 36.9 (4.9) against 38 (3.8), respectively). Both groups represent high risk factors including overweight and obesity, abdominal obesity as well as dyslipidemia. Newly diagnosed dyslipidemia was significant in the group with family history (83.3% versus 44.4%, P<0.01). Both groups were screened either into the low or moderate risk Framingham Risk Score group. CAC score was higher in family history group (11.1% vs 0%, P>0.05). In conclusion, CAC may be irrelevant for screening in younger population. However, the yield of other risk factor is still alarming.

Abstract 14925: Inverse Association between Family History of Premature Coronary Artery Disease and the Risk of Death in Patients with Coronary Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ahmed Abdi Ali ◽  
Abdel Aziz Shaheen ◽  
Danielle A Southern ◽  
Mei Zhang ◽  
Merril Knudston ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Clinical Characteristics ◽  
System Level ◽  
Premature Coronary Artery Disease ◽  
Inverse Association ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease

Background: Family history (FHx) of premature coronary artery disease (CAD) is an established cardiovascular risk factor. However the impact of FHx on outcomes of patients with CAD is unclear. Methods & Results: The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Program is an inclusive prospective registry of patients undergoing coronary angiography. Between April 2002 and Mar 2013, 99,667 patients were enrolled. 30,030 (30%) patients reported FHx, defined as a first degree relative with premature CAD (males <55, females <65 years). We investigated the association between FHx and all-cause mortality at 1 year, using multivariable logistic regression, adjusting for clinical characteristics, comorbidities, and the extent of CAD. Patients with normal angiography (15.2%) were excluded. Compared to those without FHx, those with FHx were younger (60.1 vs 64.0 years, p<0.0001), more likely female (30.5% vs 29.5%; p=0.0018), and were less likely to have previously diagnosed CAD, congestive heart failure, stroke, or chronic kidney disease (all p<0.0001) Conversely, those with FHx were more likely current smokers (31.8% vs 25.3%) and to have hypertension (68.8% vs 65.5%) and dyslipidemia (75.7% vs 68.1%), all p<0.0001). The indication for angiography was an acute coronary syndrome (ACS) in 55% of both groups (p=0.57), and the extent of CAD was similar. Overall, FHx was associated with reduced 1-year mortality in fully adjusted models (odds ratio [OR] 0.56, 95% CI 0.51 to 0.62). This protective association was present in patients with and without a previous CAD event (OR 0.66 [95% CI 0.60 to 0.78] vs 0.53 [95% CI 0.47 to 0.59], respectively), and in patients with and without an ACS (OR 0.56 [95% CI 0.50 to 0.63] vs 0.56 [95% CI 0.48 to 0.65], respectively). There was slight attenuation of association with age, but FHx remained protective even in those aged 80 or more (OR 0.72, 95% CI 0.57 to 0.90). Conclusion: In patients with angiographic CAD, a family history of premature CAD is associated with lower mortality, independent of clinical characteristics, mode of presentation, and extent of disease. Further investigation of potential patient- and system-level mediators of this seemingly paradoxical relationship is required.

Abstract 11661: A Family History of Premature Coronary Artery Disease is Associated With Location and Severity of Angiographically Defined Coronary Artery Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammad Hammadah ◽  
Riyaz S Patel ◽  
Danny J Eapen ◽  
Ayman Samman Tahhan ◽  
Nima Ghasemzadeh ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Premature Coronary Artery Disease ◽  
Left Main ◽  
Vessel Stenosis ◽  
History Of ◽  
Female Relative ◽  
Premature Cad ◽  
Artery Disease

Introduction: A family history (FH) of premature coronary artery disease (CAD) is an important prognostic risk factor. Emerging evidence suggests that CAD location as well as severity may be heritable. We sought to investigate the association between a FH of premature CAD with the location and severity of angiographically phenotyped CAD. Methods: 2854 patients undergoing coronary angiography were enrolled from the Emory Cardiovascular Biobank. A FH of CAD was defined as having any male or female relative with history of CAD at age ≤55 or ≤65 year old respectively. Coronary angiograms were phenotyped using a 17 segment AHA model. Proximal disease was defined as having ≥70% lesion in the left main or proximal portion of any of the three major epicardial arteries, while CAD severity was assessed by counting the number of vessels with ≥70% stenosis. Results: Among this population (mean age 63±12, male 67%, diabetes 33%), 21% reported a positive FH of premature CAD. After adjustment for age, gender, and traditional cardiovascular risk factors, those with a positive FH were more likely to have significant CAD than those without a positive FH (OR 1.3 (1.1-1.7)). They were 40% more likely to have single vessel (OR 1.4(1.1-1.7)) and up to 80% more likely to have multi-vessel disease (OR 1.8 (1.4-2.4)). In addition, they were also much more likely to have left main (OR 1.9 (1.3-2.8)) and proximal vessel involvement (OR 1.5 (1.2 - 1.9)), but not distal vessel stenosis (OR 1.1 (0.9-1.4)). Conclusions: A FH of CAD is associated with a greater likelihood of multi-vessel and proximal anatomical disease. Whether site specific disease is genetically mediated remains to be explored.

Subclinical atherosclerosis in subjects with family history of premature coronary artery disease

2008 ◽  
Vol 155 (6) ◽  
pp. 1020-1026.e1 ◽  
Author(s):  
Catalin Taraboanta ◽  
Evelyn Wu ◽  
Scott Lear ◽  
Stefanie DiPalma ◽  
John Hill ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Subclinical Atherosclerosis ◽  
Premature Coronary Artery Disease ◽  
History Of ◽  
Artery Disease

scholarly journals Assessment of endothelial dysfunction in young healthy first-degree relatives with family history of premature coronary artery disease using vascular doppler ultrasonography

2019 ◽  
Vol 7 (5) ◽  
pp. 1626
Author(s):  
Vinod Khandait ◽  
Chandrashekhar Atkar
Keyword(s):  
Family History ◽  
Endothelial Dysfunction ◽  
Brachial Artery ◽  
Doppler Ultrasonography ◽  
Premature Coronary Artery Disease ◽  
Non Invasive ◽  
First Degree Relatives ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease

Background: Endothelial dysfunction in young healthy first-degree relatives with family history of premature coronary artery disease was assessed in the present study using vascular doppler ultrasonography.Methods: Thirty young (10-40 years) first degree relatives of 17 patients with premature CAD without risk factors were selected for the study. Age and gender matched healthy subjects were enrolled as controls. Non- invasive assessment of endothelial dysfunction was done by vascular doppler study of brachial artery. Brachial artery diameter, velocity and blood flow were estimated in every study subject and control at rest, after stress and again at rest and after glyceryl-trinitrate (GTN) by vascular Doppler ultrasonography.Results: The percent rise in lumen diameter of brachial artery after stress i.e. reactive hyperaemia, labelled as percent rise in flow mediated dilatation (FMD), was significantly lower in family history group than in controls (8.42±3.47% vs 12.22±4.31%, p<0.05). The statistically significant difference in percent rise in FMD was observed to be consistent across different ages/genders (p<0.05). The mean percent rise in FMD among family history group with positive maternal history (8.06±3.65) was lower as compared to those with positive paternal history (8.57±3.12), but the difference was not statistically significant (p>0.05).Conclusions: Apparently healthy young subjects with family history of premature CAD have impaired endothelium dependent FMD in systemic circulation. Simple, non-invasive, cost-effective vascular doppler ultrasonography is recommended as a potential screening tool to detect subclinical atherosclerosis.

Sign in / Sign up

Export Citation Format

Share Document