Skip Navigation

European Heart Journal 2001 22(11):926-933; doi:10.1053/euhj.2000.2413
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (7)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Hengstenberg, C
Right arrow Articles by Schunkert, H
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hengstenberg, C
Right arrow Articles by Schunkert, H
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Siblings of myocardial infarction patients are overlooked in primary prevention of cardiovascular disease

C Hengstenberga,f1, S.R Holmera, B Mayera, S Engelb, A Schneiderb, H Löwelb, G.A.J Rieggera and H Schunkerta

a Department of Internal Medicine, University of Regensburg, Regensburg, Germany
b GSF—Institute for Epidemiology, Neuherberg, Germany

revised August 15, 2000; accepted August 16, 2000

Abstract

Aims Patients with arterial hypertension or hypercholesterolaemia may benefit from medical therapy for primary prevention of myocardial infarction. Preventive therapy may be particularly effective in individuals with a positive family history for myocardial infarction since such subjects are at high risk for coronary events. The objective of this population-based study was to analyse the risk profile as well as the current utilization of preventive strategies in asymptomatic siblings of patients with myocardial infarction.

Methods and Results We studied siblings of 325 patients with premature myocardial infarction from the Augsburg MONICA myocardial infarction registry by standardized questionnaire, blood pressure recordings, and biochemical measurements. Out of 580 siblings, 510 were free of coronary heart disease symptoms. With multiple risk factors being present in most asymptomatic siblings, 29·4% of asymptomatic individuals had an estimated individual 10-year risk for a major cardiovascular event of ≥20%, or when projected to the age of 60. According to the guidelines of the European Societies of Cardiology, Atherosclerosis, and Hypertension (ESC/EAS/ESH) from 1994 (1998 guidelines in parenthesis) dietary and lifestyle interventions were indicated for arterial hypertension in 48·1% (43·0%) and/or for hypercholesterolaemia in 17·3% (78·8%). Drug treatment was indicated for arterial hypertension in 27·9% (30·6%) and for hypercholesterolaemia in 13·6% (19·1%) of asymptomatic siblings. Of those individuals with the respective indication, actual drug treatment was given for arterial hypertension in 91·5% (83·3%) and for hypercholesterolaemia in 46·4% (33·0%). However, treatment targets were reached in only 31·0% (28·2%) with arterial hypertension and in 7·2% (5·2%) with hypercholesterolaemia, respectively.

Conclusions Most asymptomatic individuals with positive fraternal family history have more than one modifiable risk factor. Interestingly, a large number of these individuals appears to be under medical surveillance as many receive some sort of drug treatment. However, this therapy did not meet the treatment goals in the majority of those with arterial hypertension and/or hypercholesterolaemia. Thus, although individuals with a positive fraternal history for myocardial infarction can be easily identified, implementation of sufficient preventive strategies continues to be poor in a Western European country.

Key Words: Myocardial infarction, primary prevention, arterial hypertension, positive family history, epidemiology, coronary risk factors

f1 Correspondence: Christian Hengstenberg, MD, Department of Internal Medicine, University of Regensburg, Franz-JosefStrauß-Allee 11, 93053 Regensburg, Germany.

References

  1. N Engl J Med. 1998;339:1349–1357[Abstract/Free Full Text]
  2. Sacks FM, Pfeffer MA, Moye LA. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001–1009[Abstract/Free Full Text]
  3. Lancet. 1994;344:1383–1389[CrossRef][ISI][Medline]
  4. Shepherd J, Cobbe SM, Ford I. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–1307[Abstract/Free Full Text]
  5. Paffenbarger RSJ, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328:538–545[Abstract/Free Full Text]
  6. Collins R, Peto R, MacMahon S. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990;335:827–838[CrossRef][ISI][Medline]
  7. Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am Coll Cardiol. 1996;27:1214–1218[Abstract]
  8. Grundy SM, Balady GJ, Criqui MH. Guide to primary prevention of cardiovascular diseases. A statement for healthcare professionals from the Task Force on Risk Reduction. American Heart Association Science Advisory and Coordinating Committee. Circulation. 1997;95:2329–2331[Free Full Text]
  9. Pyörälä K, De-Backer G, Graham I, Poole WP, Wood D. Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J. 1994;15:1300–1331[Free Full Text]
  10. Wood D, De-Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis. 1998;140:199–270[CrossRef][ISI][Medline]
  11. Wood D, De-Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice. Summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. J Hypertens. 1998;16:1407–1414[CrossRef][ISI][Medline]
  12. Wood D. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J. 1998;19:1434–1503[Free Full Text]
  13. Becker DM, Becker LC, Pearson TA, Fintel DJ, Levine DM, Kwiterovich PO. Risk factors in siblings of people with premature coronary heart disease. J Am Coll Cardiol. 1988;12:1273–1280[Abstract]
  14. Snowden CB, McNamara PM, Garrison RJ, Feinleib M, Kannel WB, Epstein FH. Predicting coronary heart disease in siblings—a multivariate assessment: the Framingham Heart Study. Am J Epidemiol. 1982;115:217–222[Abstract/Free Full Text]
  15. Marenberg ME, Risch N, Berkman LF, Floderus B, de Faire U. Genetic susceptibility to death from coronary heart disease in a study of twins. N Engl J Med. 1994;330:1041–1046[Abstract/Free Full Text]
  16. Nora JJ, Lortscher RH, Spangler RD, Nora AH, Kimberling WJ. Genetic-epidemiologic study of early-onset ischemic heart disease. Circulation. 1980;61:503–508[Abstract/Free Full Text]
  17. Löwel H, Lewis M, Mormann A, Keil U. Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study. J Clin Epidemiol. 1991;44:249–260[CrossRef][ISI][Medline]
  18. J Clin Epidemiol. 1988;41:105–114[CrossRef][ISI][Medline]
  19. Hense HW, Stieber J, Döring A, Liese A, Keil U. Ten-year trends of cardiovascular risk factors in the MONICA Augsburg Region in Southern Germany. Results from the 1984/85, 1989/90, and 1994/95 Surveys. CVD Prevention. 1998;1:318–327
  20. Rose GA, Blackborn H. World Health Organisation Monograph Series No. 56. Cardiovascular Survey Methods. 1968;:172–175
  21. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460–2470[Free Full Text]
  22. Wilson PW, d'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847[Abstract/Free Full Text]
  23. Mancia G, Sega R, Milesi C, Cesana G, Zanchetti A. Blood pressure control in the hypertensive population. Lancet. 1997;349:454–457[CrossRef][ISI][Medline]
  24. Wld Hlth Statist Quart. 1988;41:115–120
  25. Berlowitz DR, Ash AS, Hickey EC. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339:1957–1963[Abstract/Free Full Text]
  26. Yanek LR, Moy TF, Blumenthal RS. Hypertension among siblings of persons with premature coronary heart disease. Hypertension. 1998;32:123–128[Abstract/Free Full Text]
  27. Eur Heart J. 1997;18:1569–1582[Abstract/Free Full Text]
  28. Capewell S, Pell JP, Morrison C, McMurray J. Increasing the impact of cardiological treatments. How best to reduce deaths. Eur Heart J. 1999;20:1386–1392[Abstract/Free Full Text]
  29. Löwel H, Engel S, Hörmann A, Gostomzyk J, Bolte HD, Keil U. Akuter Herzinfarkt und plötzlicher Herztod aus epidemiologischer Sicht. Intensivmed. 1999;36:652–661[CrossRef]
  30. Hansson L, Zanchetti A, Carruthers SG. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351:1755–1762[CrossRef][ISI][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 BMJHome page
C K Chow, A C H Pell, A Walker, C O'Dowd, A F Dominiczak, and J P Pell
Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention
BMJ, September 8, 2007; 335(7618): 481 - 485.
[Full Text] [PDF]

Home page
 AMERICAN JOURNAL OF LIFESTYLE MEDICINEHome page
M. A. Crouch
Importance of Family History in Lifestyle Management
American Journal of Lifestyle Medicine, March 1, 2007; 1(2): 122 - 128.
[Abstract] [PDF]

Home page
 Eur Heart JHome page
H.M. Krumholz
Gaps and opportunities in the practice of medicine: the need for improved systems of care
Eur. Heart J., June 1, 2001; 22(11): 889 - 890.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (7)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Hengstenberg, C
Right arrow Articles by Schunkert, H
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hengstenberg, C
Right arrow Articles by Schunkert, H
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?