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Coronary plaque burden elevated in relatives of patients with CAD
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First-degree relatives of patients with early-onset CAD who are healthy individuals were found to have a higher coronary plaque burden than patients with CAD symptoms, researchers reported.
The healthy relatives also had more unfavorable plaque features compared with symptomatic patients, Morten K. Christiansen, MD, from the department of cardiology at Aarhus University Hospital in Denmark, and colleagues wrote.
“The plaques display characteristics associated with myocardial ischemia and adverse coronary events,” they wrote.
The researchers matched 88 healthy individuals from 59 families who had first-degree relatives with early-onset CAD to 88 control patients who had atypical angina or nonanginal chest pain. The control patients had no family history of CAD and were referred for coronary CT angiography. The healthy relatives and the control patients also were matched by age and sex.
Semiautomated plaque quantification software was used by the researchers to evaluate composition. They also conducted a masked analysis of plaque burden.
Significantly more affected coronary segments were found in the healthy relatives group vs. the control group (0 segments: 30% vs. 49%; 1 to 2 segments: 27% vs. 32%; 3 to 4 segments: 18% vs. 6%; and ≥ 5 segments: 25% vs. 14%; P = .001).
With the use of a multivariate model, researchers calculated that the relative difference of total plaque was 5.8 (95% CI, 2.8-11.9); the relative difference of total calcified plaque was 2.6 (95% CI, 1.5-4.5); the relative difference of total noncalcified plaque was 5.8 (95% CI, 2.9-12); and the relative difference of total low-density noncalcified plaque was 3.6 (95% CI, 2.1-6.1).
“Although the present study may prove the presence of a significant burden of CAD in relatives with a family history of CAD, the size of the differences between the groups is reflected by the choice of symptomatic controls. Estimating the true effect size of a family history of CAD will require further studies using asymptomatic control individuals,” Christiansen and colleagues wrote.
In a related editorial, Amit Khera, MD, MSc, and Parag Joshi, MD, MHS, from the department of internal medicine at the University of Texas Southwestern Medical Center in Dallas, wrote: “Broad screening for coronary atherosclerotic plaque or vulnerable plaque using coronary CTA in those with a family history cannot be advocated at this time. However, this study certainly adds to the picture of what lies beneath a malignant family history of CHD.” – by Suzanne Reist
Disclosure: Christiansen, Joshi and Khera report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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