Screening relatives of patients with premature coronary heart disease

VDR Gene Polymorphisms in Healthy Individuals with Family History of Premature Coronary Artery Disease

Aim

The gene encoding the vitamin D receptor (VDR) is considered in many studies to be a good candidate responsible for susceptibility to several diseases such as coronary artery disease (CAD). Epidemiological data show that cardiovascular disease is one of the major health problems in Polish society. Basic studies show that genetic factors play a significant role in the pathogenesis of CAD. We conducted this clinical study to determine if the VDR gene polymorphisms TaqI (rs731236), ApaI (rs7975232), and FokI (rs2228570) could predispose healthy individuals to an increased risk of premature CAD (P-CAD) incidents.

Methods

We genotyped 845 subjects in a cohort consisting of 386 healthy volunteers with a documented P-CAD incident in their first-degree relatives and 459 healthy volunteers without family history (FH) of P-CAD. TaqI, ApaI, and FokI polymorphisms in VDR were genotyped using TaqMan assays and the endpoint genotyping method (qPCR). Statistical analyses were performed using the Power Analysis Software STATISTICA v.13.3.

Results

Although no statistical significance was found for TaqI and ApaI genotype frequencies, the AA genotype of FokI polymorphism was significantly more frequent in the study group compared to the control group (24.61% vs. 16.99%). The results of logistic regression analysis suggested a significant association between FokI polymorphism and FH of P-CAD in heathy people under the recessive model (OR: 1.26 (1.07-1.49, p = 0.007)); however, the frequency of VDR haplotypes did not differ significantly between the control and study populations.

Conclusions

FokI polymorphism is may be associated with FH of P-CAD. FokI polymorphism may predispose to the development of P-CAD among healthy people over the next years.

Household cardiovascular screening of high-risk families: a school-based study

BACKGROUND

A parental history of cardiovascular disease has a strong relationship with risk factor clusters in the offspring. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in both high and low-risk families.

DESIGN

A school-based, cross-sectional study.

METHODS

The middle schools of the 6th district of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group and 105 low-risk children with their families were recruited from the second group of schools. Anthropometric and metabolic measurements were performed.

RESULTS

The means of the waist circumference and waist-to-hip ratio were significantly higher in high-risk fathers. The means of total and low-density lipoprotein (LDL) cholesterol were significantly higher in both parents and children of the high-risk group. The means of the fasting plasma glucose were significantly higher in fathers and offspring of high-risk families. More fathers in high-risk families were smokers. The prevalence of increased total cholesterol, LDL-cholesterol and hyperglycemia (> or = 100 mg/dl) were higher in high-risk parents and children. The prevalence of increased body mass index (> or = 25 kg/m for parents and 85th percentile for children) was higher in fathers and children of high-risk families.

CONCLUSIONS

Cardiovascular risk factors are more prevalent and clustered in high-risk families. The screening of high-risk families is essential to prevent the progression of atherosclerosis from childhood and reduce the burden of cardiovascular disease in adulthood.

Risk factor indicators in offspring of patients with premature coronary heart disease in Banja Luka region/Republic of Srpska/Bosnia and Herzegovina

INTRODUCTION

Risk factor differences among offspring of patients with premature coronary heart disease (CHD) have not been widely studiem.

MATERIAL AND METHODS

We examined 161 persons from the region of Banja Luka, including 81 children (mean age: 25.9 years, 45.7% female) with a history of CHD and a control group of 80 persons (mean age: 24.1, 50% female). Medical history interviews and risk factor measurements were performed.

RESULTS

There were differences in mean body amss index (BMI) (26.1 kg/m(2) vs. 23.1 kg/m(2), p < 0.0001), waist circumference (87.7 cm vs. 83.9 cm, p = 0.002), hip circumference (99.3 cm vs. 95.84 cm, p < 0.002), systolic blood pressure (BP) (128.09 mm Hg vs. 122.7 mm Hg, p = 0.007), and diastolic BP (99.3 mm Hg vs. 95.8 mm Hg, p = 0.07). Moreover, HDL-cholesterol was significantly lower (1.1 mmol/l vs. 1.4 mmol/l, p = 0.0001), triglycerides significantly higher (2.2 mmol/l vs. 1.6 mmol/l, p = 0.001), and TC/HDL-ratio was significantly higher (5.1 vs. 4.0, p < 0.001) comparing cases and controls, respectively, adjusted for age, gender, and standard CHD risk factors total cholesterol, LDL and HDL cholesterol, smoking, systolic and diastolic BP, and BMI, those with HDL-C > 1.0 mmol/l in men and 1.2 mmol/l in women had a reduced odds (OR = 0.08, 95% CI: 0.02-0.34 of CHD as well as those with change of fat type (OR = 0.26, 95% CI: 0.11-0.60).

CONCLUSIONS

Children of parents with premature CHD have a significantly greater burden of CHD risk factors, with low HDL-C, in particular, being associated with an increased likelihood of being a child of a parent with premature CHD.

Relationship of thyroid-stimulating hormone levels to development of dyslipidemia and determination of an ideal cut-off point to start replacement therapy

BACKGROUND AND OBJECTIVE

There are studies showing a strong association between thyroid dysfunction and increased cardiovascular risk due to lipid profile changes. The purpose of this study was to assess the degree of association and predictive power of thyroid-stimulating hormone (TSH) levels in relation to lipid profile changes, identifying the TSH cut-off point beyond which lipid changes occur.

PATIENTS AND METHODS

A cross-sectional, retrospective study in Quito (Ecuador) conducted from January 2004 to December 2008 on patients first attending the endocrinology department.

RESULTS

A total of 278 histories were analyzed, and a 36.3% prevalence of subclinical hypothyroidism was found. No association was found between sex and cholesterol or between sex and low density lipoprotein (LDL). However, associations were found between sex and dyslipidemia, sex and body mass index (BMI), and sex and TSH. Linear regression analysis between LDL and TSH, cholesterol and TSH, and BMI and TSH showed significant associations in all cases, with Pearson R2 coefficients of 0.80, 0.81, and 0.85 respectively.

CONCLUSIONS

TSH levels show a statistically significant association to total cholesterol and LDL levels, but are not a good clinical predictor in this process. A cut-off point beyond which replacement therapy should be started to prevent occurrence of dyslipidemia cannot therefore be established.

Prevalence and determinants of coronary artery disease in first-degree relatives of premature coronary artery disease

BACKGROUND

This study aimed to investigate the prevalence of subclinical coronary artery disease (CAD) in first-degree relatives (FDRs) with premature CAD and its associating factors other than conventional risk factors.

METHODS

A total of 122 FDRs (58 men, 50±7 years) of patients with premature CAD were enrolled. The individuals who had undergone health checkups were included in the control group. Multidetector coronary computed tomography was performed to detect subclinical CAD.

RESULTS

The prevalence of subclinical CAD (35 vs. 14%, P<0.001) and at least 50% subclinical CAD (16 vs. 2.5%, P<0.001) was higher in FDRs than that in the control group. In conditional regression analysis, the urinary albumin-creatinine ratio showed a significant interaction with CAD in FDRs than the control (odds ratio 1.063, 95% confidence interval 1.009-1.118, P=0.021).

CONCLUSION

FDRs of premature CAD are more prevalent in subclinical CAD independent of conventional risk factors. Urinary albumin-creatinine ratio may have an interaction with the development of subclinical CAD in FDRs of premature CAD.