Arterial stiffness is increased in families with premature coronary artery disease

Abstract

Objective A positive family history of premature coronary artery disease (CAD) is a risk factor for cardiovascular disease (CVD), independent of traditional risk factors. Therefore, currently used risk algorithms poorly predict risk in these individuals. Novel methods are thus needed to assess cardiovascular risk. Pulse-wave velocity (PWV) might be such a method, but it is unknown whether PWV is increased in first-degree relatives of patients with premature CAD. Design Observational caseecontrol study. Setting Academic hospital. Patients Patients with premature CAD and a positive family history of premature CVD (n¼50), their firstdegree relatives without CVD (n¼50) and unrelated controls (n¼50). Interventions None. Main Outcome Measures PWV was measured with using an Arteriograph system. Differences in PWV were assessed by a generalised linear model and multinomial logistic regression. Results Patients with premature CAD had a higher PWV compared with first-degree relatives and controls (9.6962.90 m/s vs 8.1561.96 m/s and 7.3861.08 m/ s; p<0.05 patients vs all groups). Linear regression showed all groups related to PWV, with patients having the highest PWV and controls the lowest (p<0.0001). Furthermore, PWV was associated with first-degree relatives (OR 1.32, 95% CI 1.02 to 1.72; p<0.05) and premature CAD (OR 1.72, 95% CI 1.32 to 2.24; p<0.05) compared with controls. These findings were independent of blood pressure and other traditional risk factors. Conclusions Patients with premature CAD and their first-degree relatives had higher PWV compared with controls, independent of other risk factors. This holds promise for the future, in which arterial stiffness might play a role in risk prediction within families with premature CAD.A positive family history of premature coronary artery disease (CAD) is an important risk factor for cardiovascular disease (CVD) and is, in fact, independent of other risk factors.1e3 The associated risk increases further when relatives are affected at a younger age, with an OR of 1.3 in individuals with relatives affected below 55 years, to OR of 10 and higher in individuals with relatives affected below 45 years of age. Whereas a positive family history of CVD identifies whole families at risk, it fails to identify which specific kindred are at risk within the family. This emphasises the need to refine risk further among siblings in these families. Traditional risk score algorithms poorly predict cardiovascular risk in general, but even more in relatives of patients with premature CAD. 6 The latter reflects the fact that these individuals are referred for cardiovascular risk evaluation at a relatively young age, whereas in the traditional risk score algorithms age is the most potent factor determining risk. In addition, risk score algorithms use markers of risk in stead of identifying disease itself. Therefore, investigators keep searching for practical tools to assess subclinical disease, to identify individuals with early-onset CVD.Pulse-wave velocity (PWV), the gold standar...

Arterial stiffness in periodontitis patients and controls

“…27 Nevertheless, an increased PWV is related to ACVD, independently of the presence of wellknown cardiovascular risk factors 28 and may be a better risk predictor for ACVD. 3,15 PWV as marker of AS is a robust parameter for research purposes; it combines the function of the endothelial lining and the intima-media thickness. Emerging evidence shows that periodontal treatment could significantly improve endothelial function.…”

“…Differences in PWV were tested using analysis of covariance (ANCOVA) without correction (crude analysis, Model 1), after correction for age, sex and MAP (Model 2) and fully adjusted (Model 3), which also included hypercholesterolaemia and smoking. 15 From the analysis of covariance models, adjusted means, standard errors and confidence intervals were calculated.…”

“…The reference group consisted of a systemically healthy population (n = 50) from a previous study from our university hospital. 15 To minimise the influence of confounding risk factors, both patients and subjects in the reference group were excluded from the study, if they had, apart from periodontitis, any given disease or chronic medical condition (including diabetes mellitus, rheumatoid arthritis, bacterial infections, severe hypertension (4160 systolic and/or 4110 diastolic mm Hg) and body mass index (BMI) 435 kg m −2 . Additionally, subjects were excluded if they took any anti-inflammatory drugs or antibiotics or were o 18 years of age or pregnant.…”

“…Blood pressure, mean arterial pressure (MAP) and PWV were examined (authors WH and WJT) after an overnight fast between 0830 and 1130 h after 15 min rest in a quiet, temperature-controlled room as described previously, 15 and in strict accordance to the instructions, using the portable arteriograph system (Tensiomed Kft, Budapest, Hungary), with a laptop attached and updated software installed. PWV was defined as the distance travelled by the pulse wave divided by the time taken to travel this distance.…”

“…PWV was defined as the distance travelled by the pulse wave divided by the time taken to travel this distance. 15 MAP was defined as one third of SBP plus two thirds of diastolic BP. The measurements with the arteriograph were taken twice, with a 3 min rest in between, and the average of the two measurements was used for analysis.…”