Heart, Lung and Circulation
Original Article| Volume 27, ISSUE 2, P205-211, February 2018

Prevalence of Asymptomatic Coronary Heart Disease in the Siblings of Young Myocardial Infarction Patients as Detected by Coronary Computer Tomography Angiography: A Pilot Study

Published:April 26, 2017DOI:


      There is little data on the prevalence of coronary heart disease (CHD) in the young. The study aimed to estimate the prevalence of asymptomatic CHD in siblings of young patients with myocardial infarction (MI) using coronary computed tomography angiography (CCTA).


      Prospective observational data was collected on siblings of patients aged ≤55 years presenting with acute MI and having coronary stenosis ≥50% on invasive coronary angiography in at least one epicardial coronary artery. Inclusion criteria included ages 30–55 and 30–60 years for males and females respectively. Outcome of interest was obstructive CHD by coronary computer tomography angiography (CCTA), which was defined by either moderate (50–69% stenosis) and/or severe (≥70% stenosis).


      Fifty participants were studied of whom 20 (40%) were male. Thirty (60%) were current or ex-smokers, 4 (8%) had diabetes, 8 (16%) had hypertension and 26 (52%) had dyslipidaemia. Obstructive CHD by CCTA was detected in 9 (18%, 95% CI 9%–31%) participants and 3 (6%, 95% CI 1%–17%) participants were found to have severe luminal stenosis. The median radiation dose was 3.9 (IQR 0.9) mSv.


      Approximately a fifth of siblings of young MI patients were found to have asymptomatic but obstructive CHD detected on CCTA of which one third was severe. This is a group in whom screening for CHD warrants further investigation.


      ACE (angiotensin converting enzyme), ARB (angiotensin II receptor blocker), BMI (body mass index), CABG (coronary artery bypass grafting), CCTA (coronary computer tomography angiography), CHD (coronary heart disease), CI (confidence interval), CVA (cerebrovascular accident), HDL (high-density lipoprotein), HU (Hounsfield unit), LDL (low-density lipoprotein), LMCA (left main coronary artery), MI (myocardial infarction), mSv (millisievert), NSTEMI (non ST-elevation myocardial infarction), OR (odds ratio), PCI (percutaneous coronary intervention), PVD (peripheral vascular disease), SE (stress echocardiography), STEMI (ST-elevation myocardial infarction)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        The top 10 causes of death.
        2014 (May)
        • Lerner D.J.
        • Kannel W.B.
        Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population.
        Am Heart J. 1986; 111: 383-390
        • Laukkanen J.A.
        • Kurl S.
        • Lakka T.A.
        • Tuomainen T.P.
        • Rauramaa R.
        • Salonen R.
        • et al.
        Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men.
        J Am Coll Cardiol. 2001; 38: 72-79
        • Greenland P.
        • Gaziano J.M.
        Clinical practice. Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing.
        N Engl J Med. 2003; 349: 465-473
        • Wilson J.M.
        • Jungner Y.G.
        Principles and practice of mass screening for disease.
        Bol Oficina Sanit Panam. 1968; 65: 281-393
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • Arnett D.K.
        • Blaha M.J.
        • Cushman M.
        • et al.
        Heart Disease and Stroke statistics–2015 update: a report from the American Heart Association.
        Circulation. 2015; 131: e29-e322
        • Doughty M.
        • Mehta R.
        • Bruckman D.
        • Das S.
        • Karavite D.
        • Tsai T.
        • et al.
        Acute myocardial infarction in the young–The University of Michigan experience.
        Am Heart J. 2002; 143: 56-62
        • Loughnan M.E.
        • Nicholls N.
        • Tapper N.J.
        Demographic, seasonal, and spatial differences in acute myocardial infarction admissions to hospital in Melbourne Australia.
        Int J Health Geogr. 2008; 7: 42
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952
        • Hoit B.D.
        • Gilpin E.A.
        • Henning H.
        • Maisel A.A.
        • Dittrich H.
        • Carlisle J.
        • et al.
        Myocardial infarction in young patients: an analysis by age subsets.
        Circulation. 1986; 74: 712-721
        • Oliveira A.
        • Barros H.
        • Azevedo A.
        • Bastos J.
        • Lopes C.
        Impact of risk factors for non-fatal acute myocardial infarction.
        Eur J Epidemiol. 2009; 24: 425-432
        • Murabito J.M.
        • Pencina M.J.
        • Nam B.H.
        • D'Agostino Sr., R.B.
        • Wang T.J.
        • Lloyd-Jones D.
        • et al.
        Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults.
        JAMA. 2005; 294: 3117-3123
        • Budoff M.J.
        • Dowe D.
        • Jollis J.G.
        • Gitter M.
        • Sutherland J.
        • Halamert E.
        • et al.
        Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial.
        J Am Coll Cardiol. 2008; 52: 1724-1732
        • Ha E.J.
        • Kim Y.
        • Cheung J.Y.
        • Shim S.S.
        Coronary artery disease in asymptomatic young adults: its prevalence according to coronary artery disease risk stratification and the CT characteristics.
        Korean J Radiol. 2010; 11: 425-432
        • Chen M.Y.
        • Shanbhag S.M.
        • Arai A.E.
        Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients.
        Radiology. 2013; 267: 76-85
        • The National Health and Medical Research Council tARCatAV-CC
        National Statement on Ethical Conduct in Human Research 2007 (Updated May 2015).
        • Senior R.
        • Kenny A.
        • Nihoyannopoulos P.
        Stress echocardiography for assessing myocardial ischaemia and viable myocardium.
        Heart. 1997; 78: 12-18
        • Wilson P.W.
        • D’Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Conroy R.M.
        • Pyorala K.
        • Fitzgerald A.P.
        • Sans S.
        • Menotti A.
        • De Backer G.
        • et al.
        Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
        Eur Heart J. 2003; 24: 987-1003
        • McGorrian C.
        • Yusuf S.
        • Islam S.
        • Jung H.
        • Rangarajan S.
        • Avezum A.
        • et al.
        Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score.
        Eur Heart J. 2011; 32: 581-589
        • Bachar G.N.
        • Atar E.
        • Fuchs S.
        • Dror D.
        • Kornowski R.
        Prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing coronary multidetector computed tomography.
        Coron Artery Dis. 2007; 18: 353-360
        • Choi E.K.
        • Choi S.I.
        • Rivera J.J.
        • Nasir K.
        • Chang S.A.
        • Chun E.J.
        • et al.
        Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals.
        J Am Coll Cardiol. 2008; 52: 357-365
        • Chow B.J.
        • Small G.
        • Yam Y.
        • Chen L.
        • McPherson R.
        • Achenbach S.
        • et al.
        Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) registry.
        Arterioscler Thromb Vasc Biol. 2015; 35: 981-989
        • Ridker P.M.
        • Danielson E.
        • Fonseca F.A.
        • Genest J.
        • Gotto Jr., A.M.
        • Kastelein J.J.
        • et al.
        Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
        N Engl J Med. 2008; 359: 2195-2207
        • Tota-Maharaj R.
        • Blaha M.J.
        • McEvoy J.W.
        • Blumenthal R.S.
        • Muse E.D.
        • Budoff M.J.
        • et al.
        Coronary artery calcium for the prediction of mortality in young adults <45 years old and elderly adults >75 years old.
        Eur Heart J. 2012; 33: 2955-2962
        • Loria C.M.
        • Liu K.
        • Lewis C.E.
        • Hulley B.
        • Sidney S.
        • Schreiner P.J.
        • et al.
        Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study.
        J Am Coll Cardiol. 2007; 49: 2013-2020
        • Taylor A.J.
        • Bindeman J.
        • Feuerstein I.
        • Cao F.
        • Brazaitis M.
        • O’Malley P.G.
        Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project.
        J Am Coll Cardiol. 2005; 46: 807-814
        • Cohn J.N.
        Identifying the risk and preventing the consequences of cardiovascular disease.
        Heart Lung Circ. 2013; 22: 512-516
        • Blumenthal R.S.
        • Becker D.M.
        • Yanek L.R.
        • Aversano T.R.
        • Moy T.F.
        • Kral B.G.
        • et al.
        Detecting occult coronary disease in a high-risk asymptomatic population.
        Circulation. 2003; 107: 702-707