Gaeta G, De Michele M, Cuomo S, Guarini P, Foglia M C, Bond M G, Trevisan M
Division of Cardiology, A. Cardarelli Hospital, Naples, Italy.
N Engl J Med. 2000 Sep 21;343(12):840-6. doi: 10.1056/NEJM200009213431203.
Findings from epidemiologic and autopsy studies suggest that the offspring of patients with premature coronary disease may be at increased risk for atherosclerosis. We undertook a study to determine whether changes in brachial-artery reactivity and thickness of the carotid intima and media, two markers of early atherosclerosis, are present in adolescents and young adults with a parental history of premature myocardial infarction.
We enrolled 40 healthy young people whose parents had had premature myocardial infarction (48 percent male; mean [+/-SD] age, 19.0+/-5.2 years) and 40 control subjects who were matched with the first group according to age and sex. All the subjects underwent high-resolution B-mode ultrasound examinations for the measurement of the brachial-artery vasodilatory response after arterial occlusion (i.e., reactive hyperemia) and the intima-media thickness of the distal common carotid arteries. Lipid profiles, blood pressure while at rest, body-mass index, and smoking status were also determined.
As compared with the control subjects, the offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries (5.7+/-5.0 percent, vs. 10.2+/-6.6 percent in the control subjects; P=0.001) and greater mean intima-media thickness of the common carotid artery (0.49+/-0.08 mm, vs. 0.44+/-0.07 mm in the control subjects, P=0.004). In the subjects with a parental history of premature myocardial infarction, an inverse association was found between brachial-artery reactivity and carotid intima-media thickness (r=-0.46, P=0.003). In a conditional logistic-regression analysis, both brachial-artery reactivity and carotid intima-media thickness were significantly and independently correlated with a parental history of premature myocardial infarction.
Structural and functional changes are present at an early age in the arteries of persons with a parental history of premature myocardial infarction.
流行病学和尸检研究结果表明，早发性冠心病患者的后代患动脉粥样硬化的风险可能更高。我们开展了一项研究，以确定有早发性心肌梗死家族史的青少年和青年成人是否存在肱动脉反应性及颈动脉内膜和中膜厚度的变化，这两个指标是早期动脉粥样硬化的标志。
我们招募了40名父母有早发性心肌梗死的健康年轻人（男性占48%；平均年龄[±标准差]为19.0±5.2岁）以及40名根据年龄和性别与第一组匹配的对照者。所有受试者均接受了高分辨率B型超声检查，以测量动脉闭塞后肱动脉的血管舒张反应（即反应性充血）以及颈总动脉远端的内膜中层厚度。还测定了血脂水平、静息血压、体重指数和吸烟状况。
与对照者相比，有早发性心肌梗死家族史的后代肱动脉血流介导的反应性较低（5.7±5.0%，对照者为10.2±6.6%；P=0.001），颈总动脉平均内膜中层厚度更大（0.49±0.08mm，对照者为0.44±0.07mm，P=0.004）。在有早发性心肌梗死家族史的受试者中，发现肱动脉反应性与颈动脉内膜中层厚度呈负相关（r=-0.46，P=0.003）。在条件逻辑回归分析中，肱动脉反应性和颈动脉内膜中层厚度均与早发性心肌梗死家族史显著且独立相关。
有早发性心肌梗死家族史的人群在年轻时动脉就出现了结构和功能变化。
