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Cardiovascular risk factors of first degree relatives with family history of premature atherosclerotic disease Wu, Evelyn Pui See


The presence of premature (men <50 years; women <60 years) coronary heart disease (CHD) in a first-degree relative is a significant and independent risk factor for cardiovascular, peripheral vascular and cerebrovascular disease. First-degree relatives (FDRs) of patients with premature CHD (index patients) have increased risk of death from cardiovascular disease compared to those without a family history. The purpose of this study was to determine whether FDRs had higher prevalence and severity of traditional and non-traditional cardiovascular risk factors compared to the general Canadian population. Index patients and their FDRs (parents, siblings, and children) were recruited for the Family Atherosclerosis Counseling and Testing Study (FACTS). Cardiovascular risk assessment included measurements of lipid and biochemical markers, sociodemographic factors, anthropometry measures, as well as dietary, exercise, and smoking histories. Cardiovascular risk factors in FDRs were compared to a case-matched M-CHAT (Multicultural Community Health Assessment Trial) control population. Male index patients had significantly higher median values of body-mass-index (BMI; p = 0.002), waist circumference (p <0.001), systolic blood pressure (p = 0.026) and diastolic blood pressure (p = 0.001) than male FDRs. Median lipoprotein(a) values were higher in male index patients than their male FDRs (p = 0.014); no differences were observed between female index patients and female FDRs (p = 0.238). Though both groups were comparable in age (p = 0.130), FDR siblings had similar risk factors as index patients, except more FDR siblings were non smokers {p = 0.048) and FDR siblings were more educated (p = 0.044). Index patients and their FDR siblings had comparable median lipoprotein(a) values at 176 mg/L (102 - 476 mg/L) and 182 mg/L (59 - 474 mg/L), respectively (p = 0.516). Also, there was a higher prevalence of abdominal obesity in F DR siblings than in the index patients, which did not reach statistical significance. In general, FDRs had similar prevalence and severity of traditional lifestyle habits and cardiovascular risk factors as the M - C H A T controls. Both the FDRs and the controls were relatively healthy: over 92% of the female and 85% of the male FDRs were classified as 'lowrisk' according to the Framingham risk score, even after adjusting for positive family history., However, there were distinct differences between FDRs and controls in the frequency of elevated non-traditional risk factors, even after adjusting for age. Median lipoprotein(a) values were comparable between female FDRs at 218 (63 - 483) mg/L and female controls at 177 (96 - 270) mg/L (p - 0.331). Male FDRs, on the other hand, had significantly lower lipoprotein(a) than male controls at 105 (45 - 238) mg/L and 192 (88 - 377) mg/L, respectively (p = 0.022). Mean serum homocysteine levels were higher in both male and female FDRs at 10.9 ± 0.5 plM and 9.0 ± 0.3 |JM, compared to 8.5 ± 0.2 \xM and 7.3 ± 0.2 \xM for male and female controls, respectively (p <0.001). Mean C-reactive protein values were 1.8 ± 0.2 mg/L in male and 2.5 ± 0.2 mg/L in female FDRs; they did not differ significantly from the controls at 1.7 ± 0.3 mg/L for men and 1.7 ± 0.3 mg/L for women (p = 0.272).

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