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contribution of major cardiovascular risk factors to familial premature coronary artery disease

The GENECARD project

Vincent Jomini, MD^*, S.éverine Oppliger-Pasquali, MD^*, Vincent Wietlisbach, BA, Nicolas Rodondi, MD, Valérie Jotterand, MD^*, Fred Paccaud, MD, Roger Darioli, MD, Pascal Nicod, MD^* and Vincent Mooser, MD^*,*

^* Department of Medicine, CHUV University Hospital, Lausanne, Switzerland
Institute for Social and Preventive Medicine, CHUV University Hospital, Lausanne, Switzerland,
University Medical Policlinic, Lausanne, Switzerland

View larger version (39K): [in a new window]   Figure 1 Strategy used to recruit premature coronary artery disease (P-CAD)–affected sibling pairs and to identify patients with sporadic P-CAD. A total of 110 patients with familial P-CAD were originally identified, but 7 refused to enter the study, so that 103 probands with familial P-CAD and 110 affected siblings were eventually recruited.

View larger version (26K): [in a new window]   Figure 2 The prevalence of hypertension (HT), hypercholesterolemia (HC), obesity and cigarette smoking at the time of the event in 163 patients with familial premature coronary artery disease (P-CAD) (solid bars), 326 age- and gender-matched patients with sporadic (nonfamilial) P-CAD (hatched bars) and 489 age- and gender-matched individuals randomly sampled from the local general population (open bars). Hypertension was defined as blood pressure 160/95 mm Hg and/or prescription of antihypertensive agents; hypercholesterolemia corresponded to plasma total cholesterol levels 6.5 mmol/l and/or prescription of lipid-lowering agents; obesity was defined as a body mass index 30 kg/m2; and smoking corresponded to active cigarette smoking at the time of diagnosis or within the preceding five years. *p < 0.05; **p < 0.01; ***p < 0.001.

View larger version (18K): [in a new window]   Figure 3 The prevalence of risk factors in the general population (open diamonds), in patients with sporadic premature coronary artery disease (P-CAD) (solid triangles) and in patients with familial P-CAD (solid circles), according to age tertiles. Groups and risk factors were defined as described in the legend to Figure 2. *p < 0.05 familial versus sporadic P-CAD; ***p < 0.001.

View larger version (14K): [in a new window]   Figure 4 Aggregation of cardiovascular risk factors at the time of the event in six sibships with at least three siblings affected with premature coronary artery disease (P-CAD). Males are represented by squares and females by circles. The numbers beneath the symbols refer to the age when the diagnosis of P-CAD was made, whereas the age for the parents refers to the age at death (numbers in parentheses) or at the time that their P-CAD–affected siblings were recruited (age at death of the father for family no. 39 was unknown). Solid upper left corner = hypertension; solid lower left corner = smoking; solid upper right corner = hypercholesterolemia; and solid lower right corner = obesity and/or diabetes, as defined in the legend to Figure 2. Arrows indicate probands. Plasma cholesterol levels were missing for siblings 1 and 3 from family no. 53, sibling 1 from family no. 80 and sibling 1 from family no. 96, and the diagnosis of hypercholesterolemia was based on values obtained when these individuals were recruited. The father in family no. 80 died of P-CAD at age 49 years.