Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
JACC Cardiovasc Imaging. 2017 Oct;10(10 Pt A):1128-1135. doi: 10.1016/j.jcmg.2016.10.014. Epub 2017 Jan 18.
This study characterized and quantified subclinical atherosclerosis by coronary computed tomography angiography (CTA) in first-degree relatives of patients with early onset coronary artery disease (CAD).
A strong family history of CAD is an important risk factor for adverse cardiovascular events. Whether predisposed individuals suffer an increased burden of coronary atherosclerosis and adverse plaque features is not known.
We included 88 healthy middle-aged first-degree relatives from 59 families with early onset CAD. Participants were matched by age and sex with 88 control patients with atypical angina or nonanginal chest pain and no family history of CAD, referred for coronary CTA. A blinded analysis of plaque burden and composition was performed using semiautomated plaque quantification software. The relative differences between the median volumes or the odds ratios (OR) were compared between groups, using a mixed model.
First-degree relatives had significantly more affected coronary segments than controls (0 segments: 30% vs. 49%, respectively; 1 to 2 segments: 27% vs. 32%, respectively; 3 to 4 segments: 18% vs. 6%, respectively; and ≥5 segments: 25% vs. 14%, respectively; p = 0.001). In a multivariate model, the relative differences of total plaque, total calcified plaque (CP), total noncalcified plaque (NCP), and total low-density NCP (LD-NCP) were 5.8 (95% confidence interval [CI]: 2.8 to 11.9), 2.6 (95% CI: 1.5 to 4.5), 5.8 (95% CI: 2.9 to 12.0), and 3.6 (95% CI: 2.1 to 6.1), respectively. The adjusted OR of any positive remodeling plaque or any LD-NCP plaque was 4.2 (95% CI: 1.2 to 14) and 4.2 (95% CI: 1.9 to 9.5), respectively.
Healthy first-degree relatives of patients with early onset CAD have an increased coronary plaque burden compared with symptomatic patients. The plaques display characteristics associated with myocardial ischemia and adverse coronary events.
本研究通过冠状动脉 CT 血管造影（CTA）对早发冠心病（CAD）患者的一级亲属进行亚临床动脉粥样硬化的特征描述和量化。
家族性 CAD 病史强是不良心血管事件的重要危险因素。易患个体是否存在冠状动脉粥样硬化负担增加和不良斑块特征尚不清楚。
我们纳入了 59 个早发 CAD 家族的 88 名健康中年一级亲属。根据年龄和性别与 88 名患有非典型心绞痛或非胸痛症状且无 CAD 家族史的对照患者进行匹配，这些患者因冠状动脉 CTA 而就诊。使用半自动斑块定量软件进行斑块负荷和组成的盲法分析。使用混合模型比较组间中位数体积或比值比（OR）的相对差异。
一级亲属的受影响冠状动脉节段数明显多于对照组（0 个节段：分别为 30%和 49%；1-2 个节段：分别为 27%和 32%；3-4 个节段：分别为 18%和 6%；≥5 个节段：分别为 25%和 14%；p=0.001）。在多变量模型中，总斑块、总钙化斑块（CP）、总非钙化斑块（NCP）和总低密度 NCP（LD-NCP）的相对差异分别为 5.8（95%置信区间[CI]：2.8 至 11.9）、2.6（95%CI：1.5 至 4.5）、5.8（95%CI：2.9 至 12.0）和 3.6（95%CI：2.1 至 6.1）。任何阳性重构斑块或任何 LD-NCP 斑块的调整后 OR 分别为 4.2（95%CI：1.2 至 14）和 4.2（95%CI：1.9 至 9.5）。
早发 CAD 患者的一级亲属与有症状患者相比，冠状动脉斑块负担增加。这些斑块显示出与心肌缺血和不良冠状动脉事件相关的特征。
