Asymptomatic Individuals With a Positive Family History for Premature Coronary Artery Disease and Elevated Coronary Calcium Scores Benefit From Statin Treatment

Mulders, Ties A.; Sivapalaratnam, Suthesh; Stroes, Erik S.G.; Kastelein, John J.P.; Guerci, Alan D.; Pinto‐Sietsma, Sara‐Joan

doi:10.1016/j.jcmg.2011.11.014

Cited by 35 publications

(20 citation statements)

References 34 publications

(18 reference statements)

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“…7 Despite the fact that the outcome of the St. Francis Heart trial, which investigated the effect of atorvastatin 20 mg/day in asymptomatic individuals with a CAC score above the 80th percentile, did not reach statistical significance, a post hoc analysis showed that the combination of a positive family history and a CAC score above the 80th percentile was a subgroup within the primary-prevention population that received greater benefit from statin treatment than the population at large. 24 Our study has certain limitations. First, the number of subjects was relatively small, so subgroup analysis to identify subsets that may have benefited more from atorvastatin treatment could not be performed.…”

Section: Discussionmentioning

confidence: 86%

“…Additionally, the proportion of subjects who normalized endothelial function (RHI ≥2) after atorvastatin and placebo treatment was not significantly different (40% vs 37%, P = 1.000) (Figure 3). The augmentation index after atorvastatin treatment was not different from that after placebo treatment (24 [IQR, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] vs 29 [IQR 16-35], P = 0.922). In the subgroup analysis, these results were consistent both in subjects indicated for drug therapy (11 subjects, 31%) and subjects not indicated for drug therapy (24 subjects, 69%), according to the NCEP-ATP III guidelines.…”

Section: Resultsmentioning

confidence: 99%

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Impact of Atorvastatin Treatment in First‐Degree Relatives of Patients With Premature Coronary Artery Disease With Endothelial Dysfunction: A Double‐Blind, Randomized, Placebo‐Controlled Crossover Trial

Hong

Chang

Park

et al. 2013

Clinical Cardiology

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Background: A family history of premature coronary artery disease (CAD) is a well-known risk factor for cardiovascular events. Hypothesis: Atorvastatin may improve endothelial dysfunction (ED) in the first-degree relatives (FDRs) of patients with premature CAD with ED. Methods: Thirty-five FDRs (median age, 52 years [interquartile range (IQR), 46-57 years], 21 male) of patients with premature CAD with ED were recruited in a prospective trial with a crossover double-blind design: 6 weeks of treatment with atorvastatin 40 mg/day followed by placebo, or vice versa. After each treatment, the digital pulse wave amplitude was determined by EndoPAT to obtain the reactive hyperemia index (RHI), a measure for endothelial function. The primary outcome was the difference of RHI between atorvastatin and placebo treatment.Results: Low-density lipoprotein cholesterol was lower after atorvastatin compared with placebo treatment (124 [102-145] mg/dL vs 67 [50-73] mg/dL, P < 0.001). However, RHI was not different after atorvastatin compared with placebo treatment (1.9 [1.5-2.4] vs 1.9 [1.6-2.2], P = 0.902). Also, the augmentation index was similar after each treatment. These results were observed both in subjects who had indications for statin treatment (31%) and those who did not (69%) according to National Cholesterol Education Program Adult Treatment Panel III guidelines. Conclusions: Despite improvement in the lipid profile, atorvastatin failed to improve ED in the FDRs of patients with premature CAD with ED. Although we identified those with ED in FDRs of patients with premature CAD as a high-risk group for future cardiovascular events, atorvastatin treatment may not be a beneficial primary prevention strategy for this population.

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Section: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Impact of Atorvastatin Treatment in First‐Degree Relatives of Patients With Premature Coronary Artery Disease With Endothelial Dysfunction: A Double‐Blind, Randomized, Placebo‐Controlled Crossover Trial

Hong

Chang

Park

et al. 2013

Clinical Cardiology

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“…However, these studies were likely underpowered to detect a difference in CAC progression, and participants had very elevated baseline CAC scores, which makes interpretation of CAC progression more challenging. Interestingly, a recently completed post-hoc analysis of the St. Francis Heart Study found a significant reduction in CHD events with statin treatment for participants with a family history of premature CHD and elevated baseline CAC scores, although CAC score change was not examined in this analysis [39]. It would be interesting to see if individuals with varying degrees of risk factors, including extent of family history and CAC, demonstrate a risk-factor- and score-dependent relationship to statin response.…”

Section: Discussionmentioning

confidence: 99%

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

Pandey

Blaha²,

Sharma³

et al. 2014

Atherosclerosis

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Objective We evaluated family history as a predictor of incident and progressive coronary artery calcium (CAC) using data from the Multi-Ethnic Study of Atherosclerosis (MESA). Background MESA is a multi-center prospective study of 6,814 asymptomatic individuals. The relationship between family history of coronary heart disease (CHD) and CAC incidence or progression has not been described previously. Methods A total of 5,099 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. Results A 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. Conclusions Family 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.

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“…In patients with young CAD high C-reactive protein have been associated recurrence of future acute coronary event and raised fibrinogen levels seems to be associated with increased mortality[6]. Persons with positive family history of premature CAD and coronary artery calcium scores greater than 80 th percentiles benefit from treatment with statins for primary prevention of acute coronary events[68]. …”

Section: Prognosismentioning

confidence: 99%

Newer perspectives of coronary artery disease in young

Aggarwal

Srivastava

Velmurugan

2016

WJC

104

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Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.

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Asymptomatic Individuals With a Positive Family History for Premature Coronary Artery Disease and Elevated Coronary Calcium Scores Benefit From Statin Treatment

Cited by 35 publications

References 34 publications

Impact of Atorvastatin Treatment in First‐Degree Relatives of Patients With Premature Coronary Artery Disease With Endothelial Dysfunction: A Double‐Blind, Randomized, Placebo‐Controlled Crossover Trial

Impact of Atorvastatin Treatment in First‐Degree Relatives of Patients With Premature Coronary Artery Disease With Endothelial Dysfunction: A Double‐Blind, Randomized, Placebo‐Controlled Crossover Trial

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

Newer perspectives of coronary artery disease in young

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