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Offspring of Premature Heart Attack Victims Show Early Signs of Disease

The offspring of adults who have had premature heart attacks show signs of blood vessel disease at young ages, even when they don''t have other traditional risk factors for heart disease, report researchers in this week''s New England Journal of Medicine.

"This study found structural and functional changes at early ages in the arteries of healthy young people with a parental history of premature heart attack," said researcher M. Gene Bond, Ph.D., of Wake Forest University Baptist Medical Center. "We''ve long known that family history is a risk factor for heart disease, but it hasn''t been clear when cardiovascular abnormalities first become evident."

The study of healthy young people from ages 6 to 30 used high-resolution ultrasound to measure two indications of blood vessel health: thickness of the vessel walls and vessel function or "reactivity." Participants with a parental history of premature heart attack had vessels that were 11 percent thicker than the control group and 55 percent less reactive.

Thickened artery walls are an early sign of atherosclerosis, the buildup of plaque in the arteries that leads to heart attacks and strokes. Reactivity is an indicator of how well the vessels function. For that test, researchers measured blood flow in the brachial arteries, the major vessels in the arm, both before and after the arteries were constricted with a blood pressure cuff. In a healthy artery, blood flow increases after the constriction. Decreased reactivity is a sign of atherosclerosis.

"With ultrasonography, we''ve ''sounded out'' these early silent signs of atherosclerosis," said Bond, professor of Neurobiology and Anatomy, and director, Division of Vascular Ultrasound Research. "This technology allows us to detect vessel changes decades before the buildup of plaque results in signs or symptoms such as heart attack or stroke. This could be an important tool for evaluating patients at high risk for cardiovascular disease."

For the study, Bond and colleagues from A. Cardarelli Hospital, Federico II University, and S. Maria di Loreto Hospital in Naples, Italy, and the State University of New York in Buffalo, compared 40 healthy young people with a parental history of premature heart attack (before or at age 60) to 40 control subjects with no parental history of heart disease.

"This study is an excellent example of multi-institutional and international collaboration," said Maurizio Trevisan, M.D., M.S., professor and chairman of Social and Preventive Medicine at the University at Buffalo School of Medicine and Biomedical Sciences.

The study found no significant differences between the two groups in body mass index, blood pressure, levels of low-density "bad" cholesterol, levels of high-density "good" cholesterol, triglycerides and smoking - all traditional risk factors for heart disease.

The participants with a family history of premature heart attack showed higher concentrations of apolipoprotein B and Lp(a) lipoprotein concentrations. These factors are not considered traditional risk factors, but are currently being evaluated by physicians as possible markers for atherosclerosis.

"These observations hold great promise for better identifying populations at risk for cardiovascular disease and for developing early intervention strategies," said Barry E. Stein, Ph.D., professor and chairman of Neurobiology and Anatomy. "It is this sort of innovative approach of adapting basic science techniques to clinical problems that is likely to accelerate progress in preventive medicine."

Wake Forest University''s Division of Vascular Ultrasound Research was created in 1987 to foster international collaboration on vascular disease research. Currently, WFUBMC works with more than 35 universities in nine European countries.

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