Risk factors for coronary atherosclerosis in the elderly

The thickness of the intimal and medial layers of the carotid arteries, and the index of left ventricular mass, in children of patients with premature coronary arterial disease

OBJECTIVE

To compare the thickness of the intimal and medial layers of the carotid arteries, and the index of left ventricular mass, in children of parents suffering premature myocardial infarction, and to compare the findings with suitable controls.

METHODS

Our population comprised 112 healthy adolescents, aged from 12 to 18 years, with a parental history of onset of coronary arterial disease under 55 years of age. We compared this cohort with 127 adolescents matched for age and gender, but without any history of coronary arterial disease in their first and second relatives. The thickness of the carotid arterial layers, and left ventricular mass, were assessed by high resolution carotid ultrasonography and echo doppler examination, respectively.

RESULTS

The mean age, body mass index, systolic and diastolic blood pressures of the patients and their controls was not significantly different. The intimal and medial thicknesses, and the index of left ventricular mass, however, as well as the levels of total and low density lipoprotein cholesterol, were significantly higher in the group of patients. In the entire population studied, the levels of total and low density lipoprotein-cholesterol correlated significantly with the arterial mural thicknesses, whereas age, male gender, positive parental history of premature coronary arterial disease, low density lipoprotein-cholesterol, and the index of body mass had significant correlations with the index of left ventricular mass. After adjustment for all covariates, the association of parental history of premature coronary arterial disease with intimal and media thickness and the index of left ventricular mass remained significant (R2 = 0.3).

CONCLUSION

Our findings complement some recent observations of functional and structural changes in the arteries of young and older adults with a familial predisposition to coronary arterial disease, and emphasize the importance of primary prevention of such disease.

Correlation of parents' longevity with carotid intima-media thickness in patients attending a Lipid Clinic

The relationship between carotid intima-media thickness (IMT) and the subject's parents' longevity has been investigated. The association between parents' age at death and IMT was estimated in 593 consecutive patients attending a Lipid Clinic by survival-analysis methods. Average maximum IMT (Avg-IMT), maximum IMT (Max-IMT), clinical and laboratory variables and parental age at death, were assessed. Kaplan-Meier analyses showed significant differences in survival curves, low IMTs being associated with long-lived parents (p=0.0003 and 0.001 by log-rank test for fathers and mothers, respectively). A Cox proportional hazards regression model showed that higher carotid IMT values were associated with father's and mother's deaths at an early age, even after adjusting for conventional cardiovascular risk factors. These data were confirmed after the stratification of patients into younger (<65 y) and older (>/=65 y) or into subjects with and without a family history of dyslipidemia or vascular diseases. In addition, by stratifying subjects into those with no, one or two long-lived parents, we observed a significant trend for the combination of father's and mother's longevity on their offspring's IMTs (p<0.01 and 0.05 for Avg-IMT and Max-IMT, respectively). These data highlight a significant relationship between carotid artery IMT and a familial predisposition to be long-lived that is independent of the individual's vascular risk profile.

Coronary heart disease, hypercholesterolemia, and atherosclerosis. II. Misrepresented data

Early development of the hypercholesterolemic/lipid hypothesis of atherosclerosis was based on false premises including fallacious national mortality rates and misrepresentation of the vascular lesions in cholesterol-overfed animals and monogenic hypercholesterolemias (MH). Nonspecific coronary heart disease (CHD) was inappropriately used as a surrogate of atherosclerosis, unmeasured and unseen. Causality was assumed and implied by classifying statistical correlates of CHD as atherogenic risk factors. These faults were compounded by methodological errors, pooling of all causes of CHD, a large clinical diagnostic error, biased age selection of cohorts leading to confounding by age and MH, and emphasis on population and cohort mean values which conceal heterogeneity within cohorts and are inapplicable to individuals. Overzealous investigators neglected to review the premises and relevant pathology on which the hypothesis was based or to reconcile valid criticisms, inconsistencies, and invalidation of CHD epidemiology by pathological, experimental, and iatrogenic evidence. Statistical data, pertaining to CHD but with no scientific applicability to atherosclerosis, progressively imparted to readers a misleading perception of the relationship of serum cholesterol to CHD. Concurrently the statistical serum cholesterol range was unjustifiably abandoned. The evidence establishes that the lipid hypothesis of atherosclerosis lacks scientific basis.

Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease : the EVA study

Familial aggregation of coronary heart disease (CHD) has been reported in several studies. The specific underlying mechanisms and the relative contribution of atherosclerosis to the subsequent CHD events in subjects with family history are not well established. This study examined the association of parental history of premature death from CHD with ultrasound carotid measurements of atherosclerosis in a population of 1040 subjects aged 59 to 71 years. Ultrasound examination included measurements of intima-media thickness at the common carotid arteries (at sites free of plaques) and assessment of atherosclerotic plaques in the extracranial carotid arteries. Subjects who reported that 1 or both parents had sudden death or died of myocardial infarction before the age of 65 years were considered positive for parental history of premature death from CHD (n=53, 5.1%). The prevalence of atheromatous plaques was higher in subjects with history of premature death from CHD compared with those without history (41.5% versus 20.5%, P<0.001). Age- and sex-adjusted odds ratio of atheromatous plaques associated with parental history of premature death from CHD was 2.85 (95% confidence interval, 1.60 to 5.08; P<0.001). Multivariate adjustment for major known cardiovascular risk factors did not markedly alter the results (odds ratio, 2.70; P<0.002). In contrast, common carotid intima-media thickness was not associated with parental history of premature death from CHD (0.66+/-0.11 versus 0.66+/-0.12 mm, P=0.76). These findings were observed in both men and women. In conclusion, parental history of premature death from CHD is strongly associated with carotid plaques. Familial transmission of CHD risk does not seem to be specifically mediated by arterial wall thickening measured at sites free of plaques.