Arterial Abnormalities in the Offspring of Patients with Premature Myocardial Infarction

A BSTRACT Background The offspring of patients with premature coronary disease may be at increased risk for atherosclerosis. We undertook a study to determine whether changes in brachial-artery reactivity and the thickness of the carotid intima and media, two markers of early atherosclerosis, are present in adolescents and young adults with a parental history of premature myocardial infarction. Methods We enrolled 40 healthy young people whose parents had had premature myocardial infarction (48 percent male; mean [±SD] age, 19.0±5.2 years) and 40 control subjects who were matched with the first group according to age and sex. All the subjects underwent high-resolution B-mode ultrasound examinations for the measurement of the brachialartery vasodilatory response after arterial occlusion (i.e., reactive hyperemia) and the intima–media thickness of the distal common carotid arteries. Results As compared with the control subjects, the offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries (5.7±5.0 percent, vs. 10.2±6.6 percent in the control subjects; P=0.001) and greater mean intima–media thickness of the common carotid artery (0.49±0.08 mm, vs. 0.44±0.07 mm in the control subjects; P=0.004). In the subjects with a parental history of premature myocardial infarction, an inverse association was found between brachial-artery reactivity and carotid intima–media thickness (r=–0.46, P=0.003). In a conditional logistic-regression analysis, both brachial-artery reactivity and carotid intima–media thickness were significantly and independently correlated with a parental history of premature myocardial infarction. Conclusions Structural and functional changes are present at an early age in the arteries of persons with a parental history of premature myocardial infarction. (N Engl J Med 2000;343:840-6.)