How to improve screening in first-degree relatives of patients with premature coronary heart disease.

BACKGROUND: Guidelines on the prevention of cardiovascular disease recommend screening in close relatives of patients with premature coronary heart disease (CHD). This family history puts them at increased risk for CHD, independent of other major risk factors, but screening for CHD risk factors in these relatives is not widely practiced in Europe. This demonstration project examined how to improve screening of close relatives of patients with premature CHD in daily practice. METHODS: A controlled study design was used. Four hospitals were compared in a pre-test as to the actual screening of relatives of patients with premature CHD. Then they were arranged in pairs and randomly assigned to the Usual care (U) or Intervention group (I). An information and health education program--involving patients, relatives and family doctors--was developed in I to improve screening by the family doctor. RESULTS: The pre-test confirmed that screening of relatives of patients with premature CHD is poorly practiced in the four regions; no significant differences between I and U were observed. The screening of relatives during the study period reached 63.9% in I compared to 25.4% in U. This difference between I and U was present in siblings and offspring. The cardiovascular risk profile of the relatives of I was not optimal and needed improvement. CONCLUSION: Screening of first-degree relatives of patients with premature CHD can be significantly improved through a health education program. This is the first and necessary step to improve the management of risk factors in these people, who are at increased risk for CHD.     

Cardiovascular risk factors in first-degree relatives of patients with premature coronary artery disease

OBJECTIVE: The objective of this study was to evaluate the prevalence of coronary risk factors among Iranian first-degree relatives of patients with premature coronary artery disease (PCAD) and compare them with the general population. METHODS AND RESULTS: The study comprised 144 siblings and offspring (aged 25-64 years) of patients with angiographically documented PCAD (< 55 years in men and < 65 years in women). Body mass index, blood pressure and smoking were investigated. Fasting venous blood was analysed for lipids and fasting plasma glucose. The means of measured values and prevalence of risk factors were compared with the results obtained from the Tehran University Population Laboratory Study. Two or more atherosclerosis risk factors were found in 76% of men and 50.3% of women. Prevalence of smoking, obesity, hypertension and diabetes was 24.3%, 30%, 29.9% and 6.9%, respectively. Total cholesterol and LDL-C levels were higher than desirable in 36.8% and 15.3% of our subjects, respectively, 14.6% had lower HDL-C values and 31.9% presented hypertriglyceridaemia. Overall, 60.4% of cases revealed at least one of the lipid abnormalities. Compared with the Tehran University Population Laboratory Study men showed a higher prevalence of high LDL and triglyceride (TG) levels and obesity. High LDL-C and smoking were found to be more prevalent among women with a family history of premature CAD. CONCLUSIONS: The prevalence of coronary risk factors among first-degree relatives of patients with premature CAD is high, especially in men. Risk factor identification and modification should be considered in individuals with a positive family history of premature CAD.     

Prognostic markers in young patients with premature coronary heart disease

ObjectivesTo evaluate the survival and prognostic implications of cardiovascular, inflammatory and prothrombotic risk factors in young patients with premature coronary heart disease (CHD).MethodsFollow-up data were obtained from 353 young patients with a first cardiac event (men ≤45 years and women ≤55 years). Baseline characteristics on traditional risk factors were collected at the time of the first event, and plasma levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured one to three months after the first event to exclude an acute phase response. We performed age and sex adjusted Cox regression analyses to assess the relationship between these factors and recurrent events with three different endpoints: all cause mortality, recurrent cardiac event (myocardial infarction or revascularisation procedure), and any recurrent event (cardiac event, cerebrovascular event or all cause mortality).ResultsDuring a total follow-up time of 1483 person years (mean 4.2 years), 11 patients died (3%), 42 patients had a recurrent cardiac event (12%), and 53 patients had any recurrent event (15%). CRP was associated with an increased risk of any recurrent event (HR 1.28[95% CI = 1.02–1.59] per unit increase in lnCRP). Also, both CRP (5.00[1.04–24.04]) and fibrinogen (5.04[1.05–24.23]) were associated with all cause mortality when levels were above the 50th percentile.ConclusionsFifteen percent of young patients with a first cardiac event have a recurrent event or die within a median follow-up of 4.2 years. In these young patients we have shown that, independently of cardiovascular risk factors, high CRP levels contribute to the risk of recurrent events, including all cause mortality, and high fibrinogen levels are associated with all cause mortality.     

早发冠心病患者的临床特征和冠脉病变特点的性别差异分析

目的 探讨早发冠心病患者的危险因素、临床症状和冠状动脉病变特点的性别差异。方法 连续入选我科2009年5月~2014年10月经冠脉造影确诊的198例早发冠心病患者,分为男性组（年龄<55岁,n=135）和女性组（年龄<65岁,n=63）。观察两组在冠心病危险因素、临床症状和冠脉造影特点等方面的差异,探讨早发冠心病患者的性别特征。结果 男性组吸烟(83% vs. 5%,P<0.01)、肥胖(28% vs. 16%,P<0.05)和饮酒的比例(39% vs. 2%,P<0.01)显著高于女性组,而女性组高血压病患者的比例高于男性组(70% vs. 51%,P<0.05);两组糖尿病、血脂异常患者的比例之间差别无统计学意义。男性组血清三酰甘油水平较女性组高〔(2.0±1.4) mmol/L vs.(1.6±0.9) mmol/L,P<0.05〕,而高密度脂蛋白胆固醇〔(1.03±0.23) mmol/L vs.(1.18±0.27) mmol/L,P<0.01〕和载脂蛋白A水平〔(1.11±0.19) g/L vs.(1.20±0.23) g/L,P<0.01〕和载脂蛋白A/B比值〔(1.4±0.5) vs.(1.6±0.5),P<0.01〕则均较女性组低。男性组危险因素聚集较女性组明显〔(1.9±1.0) vs.( 1.1±0.8),P<0.01〕;职业分布中,工人在两组所占比例均较高(50% vs. 40%),但男女组间无显著差异。与男性组比较,女性下岗或无业比例较更高(12% vs. 30%,P<0.01);两组无胸痛比例(35% vs. 46 %)无显著差异,同时,男性患者出汗较为常见(44% vs. 29%,P<0.05),而女性组心悸现象则较多见(7% vs. 22%,P<0.01)。两组冠状动脉造影结果显示均以单支病变为主(49% vs. 60%),病变血管均以前降支最为多见(68% vs. 54%)。两组冠状动脉造影结果比较,病变血管数、罪犯血管分布和累及植入支架比例之间差别均无统计学意义。结论 早发冠心病患者临床特征存在性别差异,但冠状动脉病变分布特征二者之间无显著差别。     

High density lipoprotein cholesterol in male relatives of patients with coronary heart disease.

To study factors that play a role in the familial occurrence of coronary heart disease, very low density lipoprotein (VLDL) triglycerides, low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol were measured after preparative ultracentrifugation in first degree male relatives of coronary patients and in control subjects. The HDL cholesterol concentration was significantly lower in relatives of 20--71 years old than in controls. No increase of serum and LDL cholesterol was found. A low level of HDL cholesterol was observed even in the younger relatives who are less likely to have cardiovascualr disease. In older relatives low HDL cholesterol was found in the presence or absence of clinical evidence of coronary artery disease. The HDL-cholesterol concentration was inversely related to the VLDL triglycerides both in relatives and controls, but the regression lines were different ((P less than 0.001) for the relative (y = --0.166x + 0.43) and for the controls (y = 0.191x + 0.49). A low HDL cholesterol level appears to be a marker of relatives of coronary patients.     

早发冠心病危险因素和冠状动脉病变特点的研究

目的总结早发冠心病患者的临床特点,探讨其冠状动脉病变的特点及早发冠心病的危险因素。方法415例经冠状动脉造影确诊为冠心病的患者,按年龄分为早发组180例(男性≤55岁,女性≤65岁)和晚发组235例,对两组患者的临床特点及冠状动脉病变特点进行统计学比较,并应用多因素分析筛选早发冠心病的危险因素。结果早发冠心病组女性患者比例(35.6%比22.1%,P=0.003)、血脂代谢紊乱比例(74.4%比55.7%,P<0.001)、陈旧心肌梗死比例(21.1%比13.2%,P=0.032)及冠心病家族史的比例(57.8%比41.3%,P=0.001)均显著高于晚发组。与晚发组相比,早发组患者舒张压水平(73±9.0mmHg比70±7.0mmHg,P<0.001)、三酰甘油(1.99±1.34mmol/L比1.51±0.84mmol/L,P<0.001)及血清总胆固醇水平(4.65±0.91mmol/L比4.33±0.91mmol/L,P=0.001)均显著升高。冠状动脉造影结果显示,两组患者在单支、多支血管病变所占比例,累及分支血管比例及病变长度等方面差异均无统计学意义。多因素分析结果显示:女性、高三酰甘油血症、陈旧心肌梗死史、冠心病家族史是早发冠心病的危险因素。结论早发冠心病患者冠状动脉病变并不轻于晚发患者,对于早发冠心病患者亦应加强危险因素的综合防治,同时应加强对女性早发冠心病患者的重视。     

原发f生高血压合并早发冠心病患者心率震荡分析

目的探讨原发性高血压合并早发冠心病患者心率震荡（HRT）的特点及其与单纯高血压病、单纯冠心病患者HRT的差异。方法将124例住院患者根据冠脉造影结果、实验室检查、心脏超声检查、血压等分为正常对照组、高血压组、冠心病组和高血压合并冠心病组（合并组）,4组均行24h动态心电图检查,分析单次室性期前收缩后HRT的初始值（TurbulenceOnset,TO）和斜率（TurbulenceSlope,Ts）。结果对各组患者一般情况的比较分析表明,合并组与高血压组相比,早发冠心病家族史、空腹血糖水平、甘油三酯水平存在显著差异。高血压组、冠心病组、合并组的TO、TS值与正常对照组比较均有显著统计学差异（P〈0．01～0．05）;高血压组的TO、TS值与冠心病组和合并组比较亦有显著统计学差异（P〈0．01）。结论高血压、冠心病及高血压合并冠心病患者HRT指标明显异常,其中高血压合并冠心病患者HRT指标受损最严重。     

Elevated fibrinogen in the healthy male relatives of patients with severe, premature coronary artery disease.

AIMS: To assess the possible role of certain coagulation factors and associated genetic polymorphisms in families in which coronary disease has occurred prematurely. METHODS AND RESULTS: One hundred and eighty-five healthy male relatives aged 65 or less were recruited following the identification of 125 patients with confirmed, premature coronary artery disease and compared to a control group of 185 healthy, age-matched volunteers. None of the control subjects had a personal or family history of coronary artery disease. The relatives and controls were similar in terms of conventional coronary artery disease risk factors. Fibrinogen levels were elevated in relatives compared with controls and remained higher after adjustment for significant correlates, 3.0 g.l(-1) (2.9-3.1) vs 2.8 g.l(-1) (2.8-2.9),P =0.004. Factor VII coagulant activity and von Willebrand factor antigen did not differ between the groups nor were there any differences in genotype frequency for the fibrinogen beta-455 G/A polymorphism or the factor VII promoter deletion/insertion and Arg-Gln coding polymorphisms. CONCLUSIONS: A significant increase in fibrinogen levels was demonstrated in the healthy, male, first-degree relatives of patients with severe coronary artery disease. Fibrinogen may be of particular importance in subjects who, other than their family history, appear to be at low risk in terms of conventional coronary artery disease risk factors.     

Subclinical calcified atherosclerosis in men and its association with a family history of premature coronary heart disease in first- and second-degree relatives

The authors examined the associations between coronary artery calcification and a family history of premature coronary heart disease in either first-degree (immediate family) or second-degree (grandparents, aunts, uncles) relatives in 1619 asymptomatic healthy men ages 40-50 years. The prevalence of any coronary artery calcification was 19.3% in participants (n=1102) with no family history, 26.6% in those with a first-degree family history (n=203; 12.5%), 26.5% in those with a second-degree family history (n=215, 13.3%), and 30.3% with both (n=99, 6.1%, p=0.003). After controlling for the Framingham risk score, body mass index, and ethnicity, all categories of family history were significant predictors of coronary artery calcification. The odds ratios for coronary artery calcification associated with a first- (1.49; p=0.026) and second-degree (1.41; p=0.049) family history of coronary heart disease were similar. Clinical coronary risk assessments should broadly include an assessment of premature coronary heart disease in both first- and second-degree relatives.     

早发冠心病患者冠状动脉病变特点及危险因素分析

目的 探讨早发冠心病患者冠状动脉病变特点及危险因素.方法 入选我院2012年6月至2014年4月经冠状动脉造影诊断为冠心病的患者279例,根据男性年龄≤55岁、女性年龄≤65岁分为早发冠心病组和非早发冠心病组.统计患者入院基本临床资料.所有患者均检测空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）.根据冠状动脉狭窄直径≥50％累及左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）或左主干（LM）分为单支、双支（累及左主干为双支病变）及三支病变组.根据Gensini积分标准对每位患者冠状动脉病变进行评分.结果 早发冠心病组男性比例、吸烟比例、存在早发冠心病家族史的比例、TG水平显著高于非早发冠心病组（P＜0.05）.与非早发冠心病组相比,早发冠心病组患者以单支病变为主,二者在受累冠状动脉部位上并无差别.非早发冠心病组患者平均冠状动脉病变支数、平均Gensini积分高于早发冠心病组（1.97±0.82比1.66±0.93,P=0.003;8.72±6.21比48.65±8.90,P=0.000）.多因素Logistic回归分析显示,男性（95％CI：2.342～10.420,P=0.000）、吸烟（95％CI：9.468～31.220,P=0.000）、早发冠心病家族史（95％CI：8.120～23.480,P=0.001）、TG（95％CI：1.224～5.465,P=0.001）是早发冠心病患者独立危险因素.结论 早发冠心病患者冠状动脉病变特点是以单支病变为主.男性、吸烟、早发冠心病家族史、TG是早发冠心病患者的独立危险因素.积极戒烟、降低TG能够降低早发冠心病的发病率.     

早发冠心病患者合并高甘油三酯腰围表型的临床意义

目的：回顾性地分析高甘油三酯腰围表型（HTWP）在早发冠心病患者中的临床意义。 方法：收集本院经临床及冠状动脉造影确诊的早发冠心病患者123例,其中合并HTWP组71例,无HTWP组52例。测定低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、C反应蛋白（CRP）、空腹血糖、尿酸、血压等指标。结果：合并HTWP组的LDL-C、空腹血糖、CRP显著高于无HTWP组（P<0.05）;合并HTWP组急性冠脉综合征（ACS）发生率高于无HTWP组（39.44%比19.23%,P<0.05）,冠脉病变Gensini评分高于无HTWP组［（36.61±31.22）比（25.31±27.44）,P<0.05］。结论：HTWP在早发冠心病患者可作为评估冠心病的危险因素;合并HTWP与ACS发生率及冠状动脉病变严重程度有关。     

早发与晚发冠心病患者临床及冠状动脉病变特点的性别差异分析

目的:探讨早发与晚发冠心病患者临床及冠状动脉(冠脉)病变特点的性别差异.方法:收集2016年1月—2017年2月于我院心内科经冠脉造影(CAG)检查明确冠心病诊断的692例患者一般和临床资料,根据NECP-ATP Ⅲ规定将所纳入患者分为早发冠心病组(男性110例、女性83例)与晚发冠心病组(男性298例、女性201例)...     

早发冠心病患者冠状动脉病变特点及危险因素的临床研究

目的探讨早发冠心病患者的冠状动脉病变特点及相关危险因素。方法152例经冠状动脉造影确诊的冠心病患者，根据年龄分为早发冠心病组（男性〈55岁，女性〈65岁）74例和老年冠心病组78例。对两组患者的相关资料进行回顾性统计分析，比较二者的冠状动脉病变特点、血脂水平、高血压病史、糖尿病病史、冠心病家族史、吸烟史、饮酒史等，评价其是否存在差异性。结果早发冠心病组中吸烟史，冠心病家族史，血清总胆固醇高于老年冠心病组；而高血压病史、糖尿病史低于老年冠心病组。早发冠心病组冠状动脉病变多为单支病变，老年冠心病组以多支病变为主。结论吸烟、冠心病阳性家族史，高胆固醇血症均是早发冠心病的主要危险因素。冠状动脉病变特点以单支病变为主。     

Impact of a targeted intervention on lipid-lowering therapy in patients with coronary artery disease in the hospital setting

BACKGROUND: Although lipid-lowering therapy according to the National Cholesterol Education Program guidelines decreases mortality and morbidity in patients with coronary artery disease (CAD), significant undertreatment of hyperlipidemia continues to occur. This study was designed to determine the impact of an intervention targeted at improving the use of lipid-lowering therapy in patients with CAD in the hospital setting. METHODS: Cardiac case managers prompted physicians to obtain lipid profiles for patients with CAD who were not receiving lipid-lowering therapy on admission and initiate lipid-lowering therapy for patients with a low-density lipoprotein level of 130 mg/dL (3.37 mmol/L) or higher during hospitalization. The study population comprised 813 patients with CAD admitted for percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, or myocardial infarction. A retrospective chart review of lipid testing and treatment rates was conducted in 300 patients in the preintervention period, and a prospective review of rates was conducted in 513 patients during the intervention period. RESULTS: The percentage of patients with CAD not receiving lipid-lowering therapy on admission who had fractionated lipid profiles obtained during hospitalization increased from 27% preintervention to 89% during intervention (odds ratio, 18.27; 95% confidence interval, 11.61-28.74; P<.001). The percentage of patients with a low-density lipoprotein level of 130 mg/dL or higher for whom lipid-lowering therapy was initiated during hospitalization increased from 17% preintervention to 82% during intervention (odds ratio, 24.50; 95% confidence interval, 7.33-81.83; P<.001). CONCLUSIONS: The intervention provided by specialized cardiac case managers significantly increased physicians' adherence to the National Cholesterol Education Program treatment guidelines. The results of the present study suggest that intervention programs of this nature could produce a significant positive impact on cardiovascular outcomes if implemented nationally.     

早发冠心病并发高血压病患者血浆结合珠蛋白水平与冠状动脉病变程度的相关性

目的:分析早发冠心病并发高血压病患者血浆结合珠蛋白（haptoglobin,Hp）水平的变化及其与冠状动脉病变严重程度的相关性。方法: 经冠脉造影确诊的早发冠心病患者90例,非冠心病的健康体检者90例作为对照组,据血压水平分类将90例早发冠心病患者分为3个亚组:正常血压及正常高值亚组（亚组1）、Ⅰ级和Ⅱ级高血压亚组（亚组2）、Ⅲ级高血压亚组（亚组3）。检测血浆Hp浓度,比较冠心病组与对照组血浆Hp浓度的差异;分析早发冠心病不同临床亚组间血浆Hp浓度、Gensini积分的差异及分析二者的相关性。结果: 早发冠心病组的血浆Hp浓度明显高于对照组,比较有统计学差异（P<001）。早发冠心病组3个亚组的Hp血浆浓度分别为（16±05） μg/L、（17±04） μg/L和（20±06） μg/L,3组之间差异有统计学意义（P<005）。两两比较,亚组3的Hp血浆浓度高于亚组1和亚组2,差别有统计学意义（均P<005）。3个亚组Gensini积分分别为（32±19）、（33±18）和（48±28）,3亚组之间差异有统计学意义（P<005）。两两比较,亚组3的Gensini积分高于亚组1和亚组2,差别有统计学意义（均P<005）,而亚组1与亚组2的Hp浓度和Gensini积分均无显著差异。结论: Hp水平的升高与早发冠心病的发生及冠脉狭窄的严重程度有关。     

Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India

AimsThe prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown.MethodsA total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded.ResultsOf total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%).ConclusionFH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.     

Risk factors in siblings of people with premature coronary heart disease

Prior studies of the contribution of coronary disease risk factors to familial aggregation of premature coronary disease may have underestimated risk factors by relying on self-reported risk factor prevalence levels or, when risk factors have been measured, by using cut points in excess of the 90th percentile. To determine the actual prevalence of hyperlipidemia, hypertension and diabetes, and the awareness of these coronary risk factors in unaffected family members, 150 apparently coronary disease-free siblings of 86 people who had documented coronary disease before 60 years of age were studied. All subjects participated in a 1 day screening preceded by a self-administered risk factor questionnaire and a personal interview. Participation of both the index patients and siblings exceeded 86%. With the use of nationally established recommendations for blood pressure and lipids, which are based on coronary disease risk curves, screening revealed that 48% of brothers and 41% of sisters were hypertensive, 45% of brothers and 22% of sisters had a lipid abnormality, 38% of siblings were current cigarette smokers and 4.7% were diabetic. Two or more risk factors were present in 42% of brothers and 26% of sisters. More than 75% of siblings had one or more risk factors that would require intervention. When compared with a race-, gender- and age-matched reference population from the Lipid Research Clinics Prevalence Study, distributions for blood pressure and for total and low density lipoprotein cholesterol were higher for the siblings in every gender and age group.(ABSTRACT TRUNCATED AT 250 WORDS)