Association of Traditional Risk Factors with Coronary Calcification in Persons with a Family History of Premature Coronary Heart Disease: The Study of the Inherited Risk of Coronary Atherosclerosis

Valdes, Ana M.; Wolfe, Megan L.; Tate, Helen; Gefter, Warren B.; Rut, Andrew; Rader, Daniel J.

doi:10.2310/6650.2001.33901

Cited by 42 publications

(26 citation statements)

References 37 publications

(40 reference statements)

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“…In the Study of the Inherited Risk for Coronary Atherosclerosis (SIRCA), 52% of women and 78% of men with a family history of premature CHD and without CHD or diabetes had a positive coronary calcium score. 9 The mean age of men in SIRCA was 45 y and the mean age of women was 50 y. These findings suggest a high prevalence of subclinical CAD in healthy younger individuals with a family history of premature CHD.…”

Section: Discussionmentioning

confidence: 60%

“…In SIRCA, traditional risk factors accounted for less than one-third of the variations in coronary calcium. 9 Akosah et al 12 evaluated 222 younger patients admitted to the hospital with an acute myocardial infarction and found that most had few traditional CV risk factors. Only 17% would have been predicted as being at high risk based solely on their Framingham risk score, and almost 75% would not have qualified for lipid-lowering therapy based on current lipid-lowering guidelines.…”

Section: Discussionmentioning

confidence: 99%

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

Sailam¹,

Karalis²,

Agarwal³

et al. 2008

Clinical Cardiology

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Introduction: 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. Methods: 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. Results: 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 (HDL 2 ) cholesterol were the most prevalent emerging lipid risk factor and was present in 72% of the study group. More individuals had low levels of HDL 2 than total HDL (34% versus 71%; p-value = 0.001). Triglyceride-(TG)-rich remnant lipoproteins were present in 49% of patients. Conclusions: 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 HDL 2 . Individuals with a family history of premature CHD may benefit from screening for emerging risk factors to better assess their CV risk.Key words: coronary calcium, Framingham risk score, premature coronary heart disease Introduction Individuals whose parents or siblings develop coronary heart disease (CHD) at a young age are at increased risk of developing CHD themselves. A family history of premature CHD is recognized as a major risk factor for CHD in the National Cholesterol Education Program (NCEP) adult treatment panel (ATP) III guidelines, 1 and recent emphasis has been placed on screening individuals with a family history of premature CHD for established cardiovascular (CV) risk factors in order to reduce their risk of developing CHD. However, previous studies have shown that individuals with a family history of premature CHD often have normal lipid levels and few identifiable major risk factors for CHD, despite having a high prevalence of subclinical coronary artery disease (CAD). 2 -4 We hypothesized that the CV risk in the offspring of individuals with premature CHD would be underestimated by the Framingham risk score, and that their increased CV risk might be explained by factors beyond traditional CV risk factors. The NCEP ATP III guidelines have identified several emerging clinical and lipid risk factors that may contribute to CHD risk, 1 and previous studies have shown a high prevalence of these emerging risk factors in patients

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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

Sailam¹,

Karalis²,

Agarwal³

et al. 2008

Clinical Cardiology

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“…A positive relationship between VC and serum total and LDL cholesterol and triglyceride levels was shown in the general population (149,152,153). A small Japanese study found that rapid progression of coronary artery calcification was associated with high triglyceride and low HDL cholesterol concentrations in longterm hemodialysis patients (154).…”

Section: Pathophysiology Of Cvd In Ckdmentioning

confidence: 99%

The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs

Nogueira

Weir

2007

Clinical Journal of the American Society of Nephrology

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D uring the past several decades, the advent and refinement of maintenance dialysis and kidney transplantation have essentially eliminated kidney failure per se as a cause of death in developed countries. However, as patients survive many years after the development of renal failure, comorbidities develop, progress, and ultimately cause death in these individuals. Cardiovascular disease (CVD) has ranked prominent among these comorbidities, accounting for nearly half of the deaths (1). All along the continuum of chronic kidney disease (CKD)-from microalbuminuria to ESRD-a higher risk for CVD has been observed (see Epidemiology of CVD in CKD). In fact, individuals with early CKD are more likely to die of CVD than to develop ESRD (2,3). Then, among those who survive to ESRD, the all-cause CVD mortality in patients with ESRD is many-fold higher than in the general population (4). Unfortunately, the reasons for the association of CKD with CVD are not clearly understood, and the role of various clinical interventions in stemming the CVD epidemic are not well defined. Complicating the issue is the potential variation in the pathophysiology and clinical behavior of CVD through the stages of CKD.3-Hydroxyl-3-methylglutaryl CoA reductase inhibitors (statins) and other lipid-lowering drugs (LLD) have been clearly demonstrated to lessen the morbidity and mortality of CVD in the general population; therefore, there is hope that the use of these drugs may likewise help patients with CKD (In addition, it has been theorized that dyslipidemia may contribute to the progression of CKD, such that LLD may prove to slow CKD progression.) Nevertheless, given differences in epidemiology and pathophysiology of CVD in CKD, there are reasons to question whether the cardiovascular benefits of LLD that are observed in the general population will also be realized in the CKD population. It is widely acknowledged that the current medical literature provides insufficient data to guide the use of LLD in the CKD population, in large part because renal insufficiency has been an exclusion criterion for most of the randomized, controlled studies that have addressed this issue. Although consensus-based guidelines on the treatment of dyslipidemias in individuals with CKD and with kidney transplants have been published by the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) Work Groups, the nephrology and cardiology communities recognize the urgent need for high-quality clinical studies on this issue, and this has fueled the publication of subgroup analyses of previous large studies in the general population and the launching of large-scale clinical trials in the CKD population, as summarized in Table 1. To provide the reader with a better appreciation of the important issues that are germane to management of dyslipidemia in CKD, this article (1) briefly summarizes the literature on the benefits of LLD in the general population, (2) demonstrates the limited involvement of individuals with CKD in the studies in the ge...

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“…The study designs and initial fi ndings of subjects were previously reported from HHDL ( 14 ) and SIRCA ( 16 ). Subjects identifi ed with the G26S variant were compared with age-and sex-matched control subjects from both SIRCA and HHDL.…”

Section: Human Subjectsmentioning

confidence: 99%

A naturally occurring variant of endothelial lipase associated with elevated HDL exhibits impaired synthesis

Brown

Edmondson

Griffon

et al. 2009

Journal of Lipid Research

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Association of Traditional Risk Factors with Coronary Calcification in Persons with a Family History of Premature Coronary Heart Disease: The Study of the Inherited Risk of Coronary Atherosclerosis

Cited by 42 publications

References 37 publications

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

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

The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs

A naturally occurring variant of endothelial lipase associated with elevated HDL exhibits impaired synthesis

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