Background: The objective of this study was to investigate the prevalence of coronary artery disease (CAD) in first-degree relatives (FDRs) of premature CAD and its determinants.
Methods: One-hundred eight FDRs (58 (54%) men, 50 ± 7 years) of patients with premature CAD were enrolled consecutively. Demographics data, serum and urine biochemistry and coronary computed tomography angiography (cCTA) were studied. We constructed a propensity score for FDRs by multivariate logistic regression including the following risk factors: age, gender, dyslipidemia, hypertension, current smoking. 108 apparently healthy subjects who underwent health check-up were propensity matched 1:1 to FDRs. The balancing property was achieved.
Results: The prevalence of CAD (the presence of any plaque) detected by cCTA showed the tendency to increase in FDRs (38 (35%) vs. 26 (24%), p = 0.074).
Furthermore, FDRs had more CAD involving > 2 segments (29 (76%) vs. 13 (50%), p = 0.029), more obstructive CAD (>50% diameter stenosis) (13 (34%) vs. 5 (19%), p = 0.049) and more proximal preference (subjects with proximal plaques/subjects with any plaques: 92% (35/38) vs. 73% (19/26), p = 0.039) by cCTA. In conditional regression analysis, urine albumin-to-creatinine ratio (UACR) had significant interaction with CAD in FDRs than control (p = 0.042). In subgroup analysis of FDRs, subjects with CAD showed higher CACS (87.2 ± 143.0 vs. 0.3 ± 1.7, p = 0.046; OR: 1.520, 95% CI: 1.152-2.005, p = 0.003) and FRS (7.6 ± 5.1 vs. 3.1 ± 3.6, p < .001; OR: 1.281, 95% CI: 1.138-1.441, p < .001) In multiple regression analysis, high FRS was independent predictor for CAD (cut-off value: 20, sensitivity: 89%, AUC: 0.800, SE: 0.045, p < .001).
Conclusion: First-degree relatives of premature CAD had more complex (multiple, obstructive, proximal) lesions than control. UACR may have an interaction with the development of CAD in first-degree relatives of premature CAD. In subjects with FDRs, high FRS (>20) might be proposed as a reasonable cut-off for the presence of CAD.
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