Arterial Abnormalities in the Offspring of Patients with Premature Myocardial Infarction

University of Naples Federico II, Napoli, Campania, Italy
New England Journal of Medicine (Impact Factor: 55.87). 10/2000; 343(12):840-6. DOI: 10.1056/NEJM200009213431203
Source: PubMed


Findings from epidemiologic and autopsy studies suggest that the offspring of patients with premature coronary disease may be at increased risk for atherosclerosis. We undertook a study to determine whether changes in brachial-artery reactivity and thickness of the carotid intima and media, two markers of early atherosclerosis, are present in adolescents and young adults with a parental history of premature myocardial infarction.
We enrolled 40 healthy young people whose parents had had premature myocardial infarction (48 percent male; mean [+/-SD] age, 19.0+/-5.2 years) and 40 control subjects who were matched with the first group according to age and sex. All the subjects underwent high-resolution B-mode ultrasound examinations for the measurement of the brachial-artery vasodilatory response after arterial occlusion (i.e., reactive hyperemia) and the intima-media thickness of the distal common carotid arteries. Lipid profiles, blood pressure while at rest, body-mass index, and smoking status were also determined.
As compared with the control subjects, the offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries (5.7+/-5.0 percent, vs. 10.2+/-6.6 percent in the control subjects; P=0.001) and greater mean intima-media thickness of the common carotid artery (0.49+/-0.08 mm, vs. 0.44+/-0.07 mm in the control subjects, P=0.004). In the subjects with a parental history of premature myocardial infarction, an inverse association was found between brachial-artery reactivity and carotid intima-media thickness (r=-0.46, P=0.003). In a conditional logistic-regression analysis, both brachial-artery reactivity and carotid intima-media thickness were significantly and independently correlated with a parental history of premature myocardial infarction.
Structural and functional changes are present at an early age in the arteries of persons with a parental history of premature myocardial infarction.

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Available from: Giovanni Gaeta, Dec 13, 2013
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    • "Assessment of flow-mediated dilatation of the brachial artery safely and non-invasively provides a measure of the systemic endothelial function. The brachial artery response to increased shear stress has been shown to correlate significantly with invasive testing of brachial (Irace et al., 2001) and coronary endothelial function (Andersson et al., 1995), as well as with the extent and severity of coronary atherosclerosis (Neunteufl et al., 1997), and carotid artery intima-media thickness (Gaeta et al., 2000). "

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    • "Genetic factors have long been known to modulate risk of atherosclerosis and CVD [32, 33]. In studies enriched with diabetic individuals or those with CVD, the genetic contribution to variation in carotid artery IMT ranges from 42%–92% [14, 34, 35]. "
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    • "Screening and control of atherosclerosis’ risk factors are of special concern for these children who are at high-risk for premature atherosclerotic cardiovascular diseases. In addition to higher levels of lipids and lipoproteins [54], markers of oxidation [55], hs CRP [56] and immunologic factors [57], structural and functional changes in arteries are present at an early age in the arteries of individuals with a parental history of premature atherosclerosis [56, 58]. It is documented that the 19-year-old offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries and greater mean intima-media thickness of the common carotid artery. "
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