Author + information
- Received August 18, 2016
- Revision received October 24, 2016
- Accepted October 27, 2016
- Published online October 2, 2017.
- Morten K. Christiansen, MDa,∗ (, )
- Jesper M. Jensen, MD, PhDa,
- Bjarne L. Nørgaard, MD, PhDa,
- Damini Dey, PhDb,
- Hans Erik Bøtker, MD, PhDa and
- Henrik K. Jensen, MD, PhDa
- aDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- bBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Morten K. Christiansen, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Objectives 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).
Background 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.
Methods 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.
Results 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.
Conclusions 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.
- coronary artery disease
- genetic predisposition to disease
- multidetector computed tomography
This study was supported by the King Christian IX and Queen Louise Foundation and Sophus Jacobsen and Spouse Astrid Jacobsen Foundation. Dr. J.M. Jensen has received speakers honorarium from Bracco Imaging. Dr. Nørgaard has received research grants from Siemens, Edwards Lifesciences, and HeartFlow. Dr. Dey is a patent holder and receives royalties from Cedars-Sinai Medical Center. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 18, 2016.
- Revision received October 24, 2016.
- Accepted October 27, 2016.
- 2017 American College of Cardiology Foundation