Simultaneous presentation of coronary heart disease in identical twins

The development of coronary artery disease involves a complex interplay between environmental and genetic factors, with premature coronary artery disease having a strong genetic component. We present the case a pair of monozygotic identical twins presenting near simultaneously with coronary artery disease and identical atherosclerotic lesions despite significant differences in environmental risk factors and being divided geographically by 12,000 miles. This is of enormous importance and not merely curiosity value as it will have implications for the prevention of coronary artery disease, provide an opportunity for the development of new therapeutic strategies, and aid targeted primary prevention through family screening.