CHD family history linked to coronary, not carotid, atherosclerosis

Family history of CHD is significantly correlated with the development of coronary atherosclerosis, but not with carotid atherosclerosis, according to recent findings.

These results suggest a potential benefit from screening for coronary atherosclerosis in low- to intermediate-risk asymptomatic adults with family history of CHD.

In a retrospective study, researchers evaluated 662 consecutive patients seen for a routine, self-referred health examination at Seoul National University Hospital in Seoul, Korea, from 2010 to 2011. All participants were older than 30 years (mean age, 55.8 ± 9.4 years) and were asymptomatic for CHD.

During evaluation, patients underwent coronary CTA and carotid ultrasonography. They indicated symptoms of chest pain via self-reported questionnaire and provided their medical history of MI, angina, stroke, hypertension, diabetes, hyperlipidemia, family history of CHD among first-degree relatives at any age), current medications and smoking status.

Patients had a family history for CHD in 7.7% of cases. Coronary CTA indicated plaque in 32% of participants, whereas carotid ultrasonography indicated plaque in 25.2%. Coronary stenosis was significant in 4.1% of participants, and significant carotid IMT occurred in 5.6%.

After adjusting for major risk factors for CVD, researchers observed significant correlations between a family history of CHD and the presence of any coronary artery plaque (adjusted OR=2.1; 95% CI, 1.07-4.16) and significant coronary stenosis (aOR=4.92; 95% CI, 1.58-15.4). However, no association was observed between family history of CHD and the presence of any carotid artery plaque (aOR=1.27; 95% CI, 0.61-2.63) or increased carotid intima-media thickness (aOR=1.44; 95% CI, 0.4-5.22).

The addition of family history for CHD to predictive models for any coronary plaque (area under curve [AUC] 0.781 vs. 0.786, P=.0351) and significant coronary stenosis (AUC 0.772 vs. 0.808, P=.0129) yielded significant improvement to predictive value. Conversely, no significant incremental predictive value improvement was found with the addition of family history of CHD to models assessing any carotid plaque (AUC 0.748 vs. 0.748, P=.528) or increased carotid intima-media thickness (AUC 0.778 vs. 0.783, P=.591).

Analysis according to Framingham risk score indicated an association between family history of CHD and significant coronary stenosis only among patients with a low Framingham risk (P=.001).

“Our study is the first to show specific comparative evidence that [family history] of CHD is more strongly associated with coronary atherosclerosis than with carotid atherosclerosis,” the researchers concluded. “… Collectively, our results suggest the possibility that screening for coronary atherosclerosis (via [coronary artery calcium]) among low-to-intermediate-risk asymptomatic adults with [family history] of CHD may be beneficial.”

Disclosure: The researchers report no relevant financial disclosures.