Premature Coronary Artery Disease in Identical Male Twins Studied by Selective Coronary Arteriography

Abstract

Identical twin brothers with premature coronary artery disease are described. Repeat selective cine-coronary arteriograms were performed in this unique twin model and demonstrated a close similarity in location and extent of atherosclerotic lesions.

Distinct Heritable Patterns of Angiographic Coronary Artery Disease in Families With Myocardial Infarction

“…Our review of the available literature shows that 9 of 12 monozygotic twin pairs displayed concordance for proximal lesions, whereas only 3 of 12 were concordant for distal lesions. [5][6][7][8][9][10][11][12][13] This finding is congruent with our observation that stenoses are particularly heritable at proximal localizations. The reason for different heritability estimates of proximal and distal lesions remains speculative.…”

“…Until now, only a few case reports on monozygotic or dizygotic twins have investigated the hereditary aspects of coronary morphology, but even these have produced inconsistent results. [5][6][7][8][9][10][11][12][13] Therefore, a large angiographic database for patients with familial MI was established to investigate the hypothesis that specific coronary morphologies have a genetic component. Detailed heritable disease patterns could enhance clinical risk characterization and offer new opportunities for clinical follow-up investigations in relatives of affected patients.…”

Coronary artery disease in twins.

“…One (case 4) had more severe proximal coronary artery disease with adequate distal vessels for the surgical approach, but the other (case 3) also had disease involving the three major arterial trees. This similarity in location and extent of disease also has been documented in the twin pairs described previously by Kreulen et al 11 A unique blend of factors results in the development of coronary artery disease in any given person. Subtle differences from patient to patient may be responsible for the great variety in pathological lesions and clinical course.…”

“…There has been only one previous report in which selective coronary arteriography was performed in a twin pair.11 Two additional studies documented the coronary artery disease with a non-selective aortic root flush technique.8 10 The twin pairs reported herein are identical, as shown by their physical appearance, blood groups, and identical chromosomal polymorphisms (Table 1). In each pair the onset of symptoms occurred at much the same time, as has been true for other twins with coronary artery disease.6 11 Similar risk factors were present in each, including identical environment, smoking, and hyperlipidaemia in the first pair, and identical environment, hypertension, and hyperlipidaemia in the second. Neither pair gave a history of any significant alcohol use that would have accounted for the hyperlipidaemia.…”

A Polymorphism inHepatocyte Nuclear Factor 1 Alpha,rs7310409, Is Associated with Left Main Coronary Artery Disease

“…Nine of twelve monozygotic twin pairs displayed concordance for LMCAD, whereas only three of twelve were concordant for MPCAD [19, 20] (pages 91–96; 193–197). In addition, the first centimeters of both the LMCA and the right coronary artery are naturally resistant to atherosclerosis.…”