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A family-based strategy to identify and prevent premature cardiovascular disease: a feasibility pilot study
Pierre Charleux1, Niki Procopi1, Ghilas Rahoual1
1Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 47 boulevard de l'Hopital, Paris 75013, France.
Insights
A family-based cardiovascular risk assessment identified a significant familial burden of cardiovascular disease (CVD). Many young relatives could benefit from proactive primary prevention, but engaging asymptomatic adults remains a challenge.
Area of Science:
- Cardiology
- Preventive Medicine
- Genetics
Background:
- Current cardiovascular disease (CVD) prevention guidelines inadequately address young adults, even with a known family history.
- There is a need for improved strategies to identify and prevent CVD in younger populations at risk.
Purpose of the Study:
- To evaluate the feasibility and acceptability of routine family-based cardiovascular risk assessment.
- To assess first-degree relatives of individuals diagnosed with premature coronary artery disease (CAD).
Main Methods:
- Patients with premature CAD identified existing CVD and prior check-ups in first-degree relatives.
- Relatives were encouraged to seek consultation for cardiovascular evaluation if they were healthy and had no prior cardiology follow-up.
- Eligibility for initial evaluation was defined by the absence of known CVD or active primary prevention.
Main Results:
- 137 probands with premature CAD had 626 first-degree relatives evaluated.
- 24.4% of relatives had known CVD; 19.6% had coronary artery disease (CAD).
- Among siblings and adult children, 13.7% had diagnosed CVD, 19.3% were in primary prevention, and 64.2% were eligible for initial evaluation. Only 11.1% initiated screening within 12 months.
Conclusions:
- A significant familial burden of CVD was observed.
- Two-thirds of young relatives presented opportunities for proactive primary prevention.
- Engaging asymptomatic adults in family history-based cardiovascular screening poses challenges.
Aims:
Current guidelines fail to adequately guide cardiovascular prevention in young adults, even when a family history of cardiovascular disease (CVD) is known. We aim to assess the feasibility and acceptability of a routine family-based cardiovascular risk assessment in first-degree relatives of individuals with premature coronary artery disease (CAD).
Methods And Results:
Patients with premature CAD were prospectively asked about pre-existing CVD cases and previous cardiovascular check-ups among their first-degree relatives. They were then encouraged to invite their healthy and naïve to cardiology follow-up relatives to contact the cardiology department for consultation. The primary outcome was the eligibility of relatives for initial cardiovascular evaluation, defined by the absence of previously known CVD or active primary prevention. The cardiovascular status of first-degree relatives was evaluated in the families of 137 probands with premature CAD. Of the 626 identified first-degree relatives, 153 (24.4%) had known CVD, primarily CAD (19.6%). Among the 352 siblings and adult children, 48 (13.7%) were already diagnosed with CVD, 68 (19.3%) were being treated or followed for primary prevention, and 226 (64.2%) were eligible for initial cardiovascular check-up. Within 12 months, 11.1% of eligible relatives initiate screening.
Conclusion:
This pilot study revealed (i) a significant familial burden of CVD, (ii) opportunities for proactive primary prevention in two out of three of young relatives, and (iii) challenges in engaging non-symptomatic adults in a cardiovascular screening based on family history.
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