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Karout M, Dykun I, Hendricks S, Balcer B, Al-Rashid F, Totzeck M, Rassaf T, Mahabadi AA. Positive family history of premature coronary artery disease and long-term mortality in patients undergoing conventional coronary angiography. The ECAD registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The clinical value of positive family history of premature coronary artery disease (CAD) in risk prediction of cardiovascular diseases is controversial. While an association with risk factors and disease manifestation has been described in observational studies, it is not implemented in clinically established risk algorithms.
Purpose
We evaluated the association of positive family history of premature CAD with cardiovascular risk factors, presence of obstructive CAD, and long-term mortality.
Methods
The present analysis is based on the ECAD registry of patients undergoing invasive coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing follow-up information. Self-reported family history of premature CAD was categorized as positive, negative, or unknown. Baseline characteristics and presence of obstructive CAD were compared between patient with and without positive family history. Cox regression analysis was used to determine the association of positive family history with morality.
Results
Overall, data from 33,865 patient admissions (mean age: 65.0±13.1 years, 69% male) were included. Positive family history was present in 4,995 (14.8%) patients, negative family history in 17,806 patients (52.6%), while family history of premature CAD was unknown in 11,064 (32.7%) patients. Patients with positive family history were significantly younger (63.6±12.4 vs. 65.9±13.3 years, p<0.0001), more frequently had diabetes (11.4 vs. 9.3%, p<0.0001), and more frequently were active smokers (23.5 vs. 13.8%, p<0.0001). Obstructive CAD with need for revascularization therapy was more frequently present in patients with positive family history (36.2 vs. 30.2%, p<0.0001), while highest rate of obstructive CAD was observed in patients without known status regarding family history (37.9%, p<0.0001). In multivariable Cox regression analysis, known positive family history as compared to no family history of premature CAD was associated with best long-term survival (hazard ratio [95% confidence interval]: 0.65 [0.59–0.70], p<0.0001), while slightly higher mortality was observed for patients with unknown status (1.14 [1.08–1.21], p<0.0001). Kaplan-Meier analysis revealed, that patients with unknown family status regarding premature disease had worst short to intermediate-term survival (figure 1).
Conclusion
Positive family history of premature CAD is associated with younger age, higher rates of smoking and diabetes, and higher frequency of obstructive coronary artery disease, while long-term survival was improved as compared to patients without family history of premature CAD. In contrast, patients with unknown status regarding family history of CAD seem to represent a heterogeneous cohort and may qualify for intensified workup, as they have highest rates of obstructive CAD and poorest short- to intermediate survival.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Survival by status of family history
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Affiliation(s)
- M Karout
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - I Dykun
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - S Hendricks
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - B Balcer
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - F Al-Rashid
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - M Totzeck
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - A A Mahabadi
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
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Keyvani K, Münster Y, Kurapati NK, Rubach S, Schönborn A, Kocakavuk E, Karout M, Hammesfahr P, Wang YC, Hermann DM, Teuber-Hanselmann S, Herring A. Higher levels of kallikrein-8 in female brain may increase the risk for Alzheimer's disease. Brain Pathol 2018; 28:947-964. [PMID: 29505099 DOI: 10.1111/bpa.12599] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/28/2018] [Indexed: 01/21/2023] Open
Abstract
Women seem to have a higher vulnerability to Alzheimer's disease (AD), but the underlying mechanisms of this sex dichotomy are not well understood. Here, we first determined the influence of sex on various aspects of Alzheimer's pathology in transgenic CRND8 mice. We demonstrate that beta-amyloid (Aβ) plaque burden starts to be more severe around P180 (moderate disease stage) in female transgenics when compared to males and that aging aggravates this sex-specific difference. Furthermore, we show that female transgenics suffer from higher levels of neurovascular dysfunction around P180, resulting in impaired Aβ peptide clearance across the blood-brain-barrier at P360. Female transgenics show also higher levels of diffuse microgliosis and inflammation, but the density of microglial cells surrounding Aβ plaques is less in females. In line with this finding, testosterone compared to estradiol was able to improve microglial viability and Aβ clearance in vitro. The spatial memory of transgenics was in general poorer than in wildtypes and at P360 worse in females irrespective of their genotype. This difference was accompanied by a slightly diminished dendritic complexity in females. While all the above-named sex-differences emerged after the onset of Aβ pathology, kallikrein-8 (KLK8) protease levels were, as an exception, higher in female than in male brains very early when virtually no plaques were detectable. In a second step, we quantified cerebral KLK8 levels in AD patients and healthy controls, and could ascertain, similar to mice, higher KLK8 levels not only in AD-affected but also in healthy brains of women. Accordingly, we could demonstrate that estradiol but not testosterone induces KLK8 synthesis in neuronal and microglial cells. In conclusion, multiple features of AD are more pronounced in females. Here, we show for the first time that this sex-specific difference may be meditated by estrogen-induced KLK8 overproduction long before AD pathology emerges.
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Affiliation(s)
- Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Yvonne Münster
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Nirup K Kurapati
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Sebastian Rubach
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Andreas Schönborn
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Emre Kocakavuk
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Mohamed Karout
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Pia Hammesfahr
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Ya-Chao Wang
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Dirk M Hermann
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Sarah Teuber-Hanselmann
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Arne Herring
- Institute of Neuropathology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
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