[Own and Parental Predictors of Hypertriglyceridemia in Children of Persons with Early Ischemic Heart Disease].

AIM: to elucidate predictors of high level of basal triglycerides (TG) in blood of children of persons with early (onset: men ≤55, women ≤60 years) ischemic heart disease (EIHD). MATERIALS AND METHODS: We examined 316 families: patients (probands) (n=295; 77.9 % after MI) with EIHD, their spouses (n=219; 83.1 % women) and native children of probands (n=413; 55.7 % men) aged 5-38 years. In children aged 5-17 and 18-38 years proband's spouse was mother in 88 and 77 % of cases, respectively. Hypertriglyceridemia in children (HTG) was defined in persons aged 5-17 years as ≥90 percentile (Lipid Research Clinics), ≥18 years - ≥1.7 mmol / l or HTG drug treatment. Predictors of HTG were selected by binary logistical regression with adjustment for age, sex and drugs. RESULTS: HTG was found in 31 / 158 children aged 5-17 years. Its independent predictors were systolic arterial pressure (odds ratio [OR] of top [>108] vs. two bottom [≤108 mm Hg] tertiles 3.85, 95 % confidence interval [CI] 1.38-10.7, р=0.010), heart rate (HR, OR of top [>78] vs. two bottom [≤78 bpm] tertiles 2.94, 95 % CI 1.20-7.23, р=0.019), and high density lipoprotein cholesterol (HDL-C, OR 0.35, 95 % CI 0.13-0.94; р=0.038) of their children; HR (OR of top [>72] vs. two bottom [≤72 bpm] tertiles 3.56, 95 % CI 1.38-9.11, р=0.008), low density lipoprotein cholesterol (OR 2.49, 95 % CI 1.12-5.52, p=0.025]), and type 2 diabetes (OR 25.9, 95 % CI 1.01-665.3; p=0.049) of the parent - proband's consort. HTG was found in 35 / 255 children aged 18-38 years and was associated with own age (OR 1.10, 95 % CI 1.02-1.19, р=0.012) and male sex (OR 6.21, 95 % CI 2.45-15.8; р=0.000). HTG was independently associated with body mass index (OR top [>25.4] vs. two bottom [≤25.4 kg / m2] tertiles 4.94, 95 % CI 2.13-11.4, р=0.000); basal glycemia (OR top [5.1] vs. two bottom [≤5.1 mmol / l] tertiles 2.52, 95 % CI 1.17-5.43, р=0.019); HDL-C (OR 0.17, CI 0.04-0.81, 0.027); alcohol consumption (OR consuming more than once vs. once a week and less 2.27, 95 % CI 1.02-5.02, p=0.044) of these children; HDL-C (OR 0.19, 95 CI 0.04-0.94; p=0.041) of the proband-parent. CONCLUSIONS: HTG in children aged 5-38 years with parental early IHD was independently associated mainly with own characteristics, forming components of metabolic syndrome. Attention should be paid to the dominance of maternal transmission in children and adolescents (age group 5-17 years).

[Own and Parental Predictors of Low Blood Level of High Density Lipoprotein Cholesterol in Offspring of Persons With Early Coronary Heart Disease].

AIM: to elucidate own and parental predictors of low levels of high density lipoprotein cholesterol (HDL-C) in blood of children of persons with early coronary heart disease (ECHD) (onset less or equal 55 years, men, or less or equal 60 years, women). METHODS: We examined 305 families: probands with ECAD (n=289, 69.2% men), their spouses (n=213, 17.8% men) and native children of probands (n=399, 56.1% men) aged 5-38 years. Low level of HDL-C in children aged 5-17 years we defined as less or equal 25 percentile (the Lipid Research Clinics, 1981), in children aged 18-38 years - <1.03 (men) and <1.29 (women) mmol/l. Predictors of low HDL-C were selected by logistical regression with adjustment for sex and age. RESULTS: Low HDL-C was revealed in 48/152 (31.6%) children aged 5-17 years. Its independent predictors were own higher triglycerides (TG) and low HDL-C of spouse. Odds ratio (OR) of top (>0.94 mmol/l) vs two bottom ( less or equal 0.94 mmol/l) tertiles of TG 2.68 (95% confidence interval [CI] 1.03-6.94; =0.043); low HDL-C of spouse 2.33 (95% CI 1.03-5.26; =0.041). Low HDL-C was revealed in 91/247 (36.8%) offsprings aged 18-38 years. Its independent predictors were higher waist circumferences (WC, OR top [>85 cm] vs bottom [ less or equal 73 cm] tertile 5.43, 95% CI 2.39-12.3; =0.000) and TG (OR 1.45, 95% CI 1.01-2.09; =0.047) of these children, atherogenic dyslipidemia of proband (OR 2.44, 95% CI 1.34-4.44; =0.0036); metabolic syndrome (OR 4.14, 95% CI 1.96-8.75; =0.0002) and lower heart rate (OR top [>72 bpm] vs two bottom [ less or equal 72 bpm] tertiles 0.41, 95% CI 0.17-0.97; =0.043) of consort-parent. CONCLUSIONS: In this group of different age children with parental ECHD independent predictors of low HDL-C were mostly own (TG) and parental metabolic factors.

[High lipoprotein(a) in children of patients with premature coronary artery disease: relation to own and parental factors].

AIM: To elucidate associations between high level of lipoprotein(a) [Lp(a)] in children of persons with premature (onset <55 years, men; <60 years, women) coronary heart disease (PCHD) with own and parental characteristics. MATERIAL AND METHODS: We surveyed 133 families: probands (n=122, 80.7% men) with PCHD, spouses (n=95, 12.1% men) and native probands children (n=177, 55.8% men) aged 5-34 years. Factors associated with high ( more or equal 30 mg/dl) LP(a) were selected by logistical regression with adjustment for sex and age separately in younger (5-17 years, n=83) and adult (18-34 years, n=94) children. RESULTS: High LP(a) was high in 21 (25.3%) younger children. Factors independently associated with high LP(a) in this group were apoprotein B (apo B) (odds ratio [OR] 1.03, confidence interval (CI) 1.00-1.05, =0.025) and plasminogen 1.03 (CI 1.01-1.06, =0.027) of these children; high Lp(a) 8.92 (CI 1.98-40.2, =0.0044) and apo B 1.03 (CI 1.00-1.05, =0.047) of consort-parent; high Lp(a) 12.3 (CI 2.88-52.8, =0.0007), high education 5.59 (CI 1.36-23.1, =0.017) and atherogenic dyslipidemia (a-DLP) 0.16 (CI 0.04-0.74, =0.019) of proband-parent. LP(a) was high in 25 (26.6%) adult children. It was independently associated with own low density lipoprotein cholesterol (LDL-C) 1.71 (CI 1.09-2.69, =0.019); high Lp(a) 13.6 (CI 2.39-77.7, =0.0033) and LDL-C 3.38 (CI 1.28-8.92, =0.014) of consort-parent; high Lp(a) 26.9 (CI 5.48-132.3, =0.0001) and a-DLP 0.13 (CI 0.02-0.82, =0.030) of proband-parent. CONCLUSIONS: High Lp(a) levels in these groups of children of patients with premature CHD were associated with characteristics of both parents especially with their elevated Lp(a). Other predictors of high LP(a) were also plausible except high education of proband-parent which possibly reflected some unaccounted factors. Association of high Lp() of children of both age groups with atherogenic dyslipidemia of proband-parent requires confirmation.

[Own and parental predictors of high level of low density lipoprotein cholesterol at children of persons with "premature" coronary heart disease].

AIM: To elucidate associations between high low density lipoprotein cholesterol (LDL-C) in children of persons with premature coronary heart disease (PCHD) and their own and parental characteristics. METHODS: We examined members of 282 families: probands (n = 262, 70.1% men) with PCHD (onset before 55 [men] or 60 [women] years), their spouses (n = 192, 19.2% men), and children of probands (n = 372, 55.8% men) aged 5-38 years. We defined high LDL-C in children aged 5-17 years as a90 percentile (Lipid Research Clinics Program Prevalence Study), in children aged 18-38 years - > or = 3.36 mmol/l. Factors related to children's high LDL were selected by logistic regression with sex and age adjustment. RESULTS: High LDL-C was found in 40/155 (25.8%) children aged 5-17 years. It was independently related to non-smoking of proband's spouse, higher own body mass index (BMI), LDL-C of proband and his spouse, lower heart rate of proband. High LDL-C was revealed in 85/217 (39.2%) children aged 18-38 years. It was independently related to metabolic syndrome of parent-nonproband, higher level of LDL-C of both parents, lower height of proband. INTERPRETATION: Most associations of high LDLAC of offsprings of patients with PCHD including negative relation to height and heart rate of proband are plausible. Association with parental nonsmoking can be result of analysis of unreliable data from small group but also reflect better economical conditions and more atherogenic nutrition of nonsmokers in Russia.

[Metabolic syndrome in families of patients with premature coronary heart disease: impact of 2009 Joint Interim Statement criteria].

AIM: To assess effect of transition from metabolic syndrome (MS) definition of International Diabetic Federation (IDF, 2005) to definition of Joint Interim Statement (JIS, 2009) on proportion of persons with MS among patients with premature coronary heart disease (CHD) and members of their families. MATERIAL: We examined 817 members of 375 families: 353-probands with premature CHD (65.7% men, 77.6% after MI, age 23-67 years); their 212 consorts (18.9% men, 5.7% with CHD, age 28-67 years), and 252 their children (52.4% men, without overt CHD, age 16-46 years). Parameters analyzed included body mass index (BMI), waist circumference, systolic/diastolic BP, serum high density lipoprotein (HDL) cholesterol (CH), triglycerides (TG). Impaired fasting glucose (IFG) and diabetes mellitus (DM) we defined according to ADA criteria. High BP was defined as prehypertension or hypertension (NHBPEP 4 report on high BP in children/adolescents or JNC 7 criteria, depending on age). RESULTS: Portions of individuals with MS according to JIS and IDF definitions were in the whole population 335/817 (41.0%) and 305/817 (37.3%), among probands 62.9% and 56.1%, consorts 37.3% and 36.8%, adult children 13.5% and 11.5%, respectively. All 305 persons with IDF MS satisfied JIS definition but JIS criteria identified MS in 30 more persons (25 with CHD). They were predominantly men (22/30), not obese (BMI range 19.1-29.1; median 25.5 kg/m2), with 3-4 AHA/NHLBI (2005) MS components, most had low HDL-CH (27); high TG (26), high BP (24), 14 persons had IFG, 5 - DM. CONCLUSION: In this heterogeneous population the use of JIS definition resulted in diagnosis of MS in small additional portion (9%) of persons with obvious high risk already requiring interventions because of CHD and/or level of CHD risk factors.

[Waist circumference below metabolic syndrome harmonizing criteria is associated with increased cardiovascular risk].

AIM: To test the hypothesis that waist circumference (WC) just below Joint Interim Statement ([JIS], 2009) abdominal obesity thresholds can be associated with worse risk factors profile than smaller WC. METHODS: In a study of risk factors in families of patients with "premature" coronary heart disease (CHD) we examined 229 persons without CHD with body mass index (BMI) 18.5 kg/m and WC <94 cm (men) or <80 cm (women) (67 spouses [28-62 years] and 162 children [16-37 years]) of probands. Risk factors studied included smoking, BMI, WC, BP, total and high density lipoprotein cholesterol (HDL C), triglycerides (TG), basal serum glucose, diabetes and metabolic syndrome (MS JIS criteria, 2009). High BP was defined as prehypertension (PreHT) or hypertension (HT) and named PreHT/HT. In persons aged 16-17 years we used criteria 4 th report of National High BP Education Program Working Group on High BP in Children and Adolescents, in persons 18 years - 7 th Joint National Committee Report (USA). TG 1.7 mmol/l, serum basal glucose 5.6 mmol/l were defined high, HDL C <1.0 mmol/l (men), <1.3 mmol/l (women) - low. Framingham risk score of cardiovascular disease (CVD) was calculated for persons aged 30 years. Factors associated with various ranges of WC were selected by logistical regression univariate analysis. Odds ratios were compared in 2 groups of WC distribution: top ( 83 cm men, 73 cm women - intermediate [I] WC) vs 2 lower (<83 cm men; <73 cm women) tertiles. Analysis was carried out in 2 age groups according to median age: 16-26 years (n=115, 23.5% with IWC) and 27-62 years (n=114, 50.0 % with IWC). RESULTS: Persons aged 16-26 years with IWC had significantly higher risk to have high TG, low HDL C and PreHT/HT than those with smaller WC: odds ratios 7.53 (95% confidence interval [CI] 1.69-33.6; p=0.008), 3.56 (95% CI 1.35-9.36; p=0.010) and 2.22 (95% CI 1.13-4.36; p=0.020), respectively. No significant relationship was found between IWC and registered risk factors in age group 27-62 years. In persons aged 30-62 years (n=90, 51.1% with IWC) IWC was related to presence of 5% Framingham risk score: OR vs smaller WC 2.59 (95% CI 1.01-6.67; p=0.048). CONCLUSION: Among younger consorts and adult children of patients with "premature" CHD persons with WC 83 - <94 cm (men), 73 - <80 cm (women) had worse risk factors profile compared with persons with smaller WC.

[Own and parental predictors of arterial prehypertension and hypertension in children of persons with premature coronary heart disease].

AIM: to elucidate own and parental predictors of arterial prehypertension (PreHT) and hypertension (HT) in children of patients with premature manifested before 55 years in men or before 60 years in women) coronary heart disease (CHD). METHODS: We surveyed 276 families: 258 probands parents with premature CHD, their 214 spouses and 362 native probands children aged 5-37 years. In persons aged 17 years we used criteria of 4 th Report National Education Program Working Group on High BP in Children and Adolescents, in persons 18 years - 7 th Report Joint National Committee (USA). Predictors were selected by logistical regression with adjustment for sex and age. RESULTS: PreHT/HT was revealed in 26/143 (18.2%) children aged 5-17 years. Their own (body mass index [BMI], waist circumference, glucose) and parental (diastolic BP of proband) predictors related to the presence of PreHT/HT with <0.1 in univariate analysis were included in stepwise regression procedure. PreHT/HT was independently associated only with higher own BMI: odds ratio (OR) of top vs bottom tertile 10.2 (95% confidence interval [CI] 1.99-52.8; p=0.005). PreHT and HT were found in 75/219 (34.2%) and 40/219 (18.3%) children aged 18-37 years, respectively. Their own (BMI, waist circumference, glucose, triglycerides and total cholesterol) and parental (waist circumference, BMI, diabetes mellitus, PreHT/HT and triglycerides of proband; education level, alcohol consumption and oral hormonal contraceptive drugs use of spouse) predictors selected in univariate analysis with <0.1, were included in stepwise regression procedure. HT was independently associated with higher BMI (OR top vs bottom tertile 19.9 [95% CI 4.34-90.8]; <0.0001) and glucose (OR top vs bottom tertile 7.85 [95% CI 2.73-22.6]; <0.0001) of children, and PreHT/HT of probands (OR 2.80 [95% CI 1.13-6.94]; =0.026). CONCLUSION: PreHT and HT (age group 5-17 years) and HT (age group 18-37 years) in children of persons with premature CHD were independently related to own "metabolic" risk factors (BMI in both age groups and basal glucose in adult children). Association of preHT/HT of proband with HT in their children became manifested later in childrens life (18-37 years).

[Spousal concordance for factors related to metabolic syndrome in families of patients with premature coronary heart disease].

PURPOSE: To elucidate risk factors concordance between spouses in families of patients with "premature" coronary heart disease (CHD). METHODS: We examined 174 spouse pairs. There were 174 probands with "premature" (onset before 55 years) CHD aged 32-63 years and 174 their spouses aged 28-63 years. Among probands 18.4% had angina pectoris only and 81.6% had history of myocardial infarction. There were 10 patients with CHD among spouses (5.75%). Characteristics studied included alcohol consumption, tobacco smoking, education, body mass index (BMI), waist circumference (WC), heart rate, systolic and diastolic blood pressure (DBP), total, low and high density lipoprotein cholesterol, triglycerides (TG), apoproteins -I and B, lipoprotein (a), blood glucose and insulin, homeostasis model assessment-insulin resistance (HOMA IR), fibrinogen, activity of plasminogen activator inhibitor type 1. Concordance of variables of continuous and ordinal type was estimated by Spearmanis rank correlation coefficients adjusted for sex and age. Pairs were divided according to proband age (32-47 and 35-63 years) and spousal concordance for characteristics studied was evaluated separately in 2 groups distinguished by age of proband (probands 32-47, spouses 28-53 years, and probands 48-63, spouses 35-63 years) with presumably different duration of marriage/cohabitation. RESULTS: Registered characteristics of spouses except apo -I correlated positively. Correlations between 9 characteristics were significant: education, insulin, HOMA IR, WC (R=0.608, 0.424, 0.421, 0.294; all p=0.0001), glucose (R=0.261; p=0.0007), TG and fibrinogen (both R=0.222; p=0.0036 and 0.0063, respectively), BMI and DBP (R=0.195 and 0.185, respectively; both p<0.016). All correlations were similar in groups of "younger" and "older" pairs with exception of PAI 1 activity (R = -0.035 and 0.320, respectively; p=0.042). CONCLUSION: In families of patients with premature CHD we found various degree of spousal concordance for risk factors mostly those considered to be related to metabolic syndrome. Correlations between risk factors levels in groups with presumably different duration of marriage were similar suggesting that concordance was due to assortative mating.