Clinical characteristics of patients with premature lower extremity atherosclerosis associated with familial early...

In the past decade we experienced a steady growth in the number of young smokers with severe premature lower extremity atherosclerosis (PLEA) and high frequency of familial cardiovascular disease (Fam CVD). The widely used Framingham risk score does not include Fam CVD among predictors of incident CVD.

We studied 370 patients younger than 55 with severe PLEA (45% females, 96% smokers) treated between 1998 and 2004. Overall, 312 (85%) patients reported a positive history of Fam CVD; 217 (59%) had family history of premature CVD (FamP-CVD), and 29% had history of early malignancies in family members <60 years (Fam Mal <60).

Patients with FamP-CVD compared to those without FamP-CVD had similar prevalence of traditional risk factors, and concentrations of metabolic and inflammatory parameters, however had greater prevalence of clinical coronary artery disease (P=0.03), cerebrovascular disease (P=or<0.01) or both (P<0.01). Patients with both FamP-CVD and Fam Mal <60 (n=58) when compared to those with neither (n=92), had greater frequency of dyslipidemia (P=0.02) and coronary revascularizations (P=0.02). Patients with Fam P-CVD had 3-fold higher odds of prevalent CVD compared to those without Fam P-CVD. This association was independent of demographic and cardiovascular risks.

In patients with PLEA, familial premature CVD may predict early clinical manifestations of systemic atherosclerosis, independently of traditional risk factors. Patients with family history of early malignancies had similar clinical characteristics, including prevalence of CVD.