Subclinical atherosclerosis in subjects with family history of premature coronary artery disease.

BACKGROUND: First-degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and nontraditional cardiovascular risk factors to carotid ultrasound measures of subclinical atherosclerosis. METHODS AND RESULTS: B-mode carotid ultrasound was used to assess the combined intimamedia thickness and plaque burden in 111 FDRs (65 men, 44.4 +/- 11 and 46 women, 44.7 +/- 13 years old) of 82 index patients (men <50 and women <60 years of age at the time of the event). The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity, and body mass index. First-degree relatives had increased average total thickness (a combined measure of intimamedia thickness and plaque) compared to controls (0.76 mm, interquartile range [IQR] 0.69-1.01 vs 0.69 mm, IQR 0.60-0.88, P < .001) even after adjusting for age, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic blood pressure, waist circumference, and smoking (beta = 0.143, P < .05). No differences were observed in average intimamedia thickness measurements alone. Of the nontraditional risk factors, only plasma homocysteine was higher in FDRs then in controls (9.6 mg/L, IQR 8.0-11.1 versus 7.5 mg/L, IQR 6.4-8.7, P < .001), after adjusting for all other confounding variables. CONCLUSION: First-degree relatives of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Noninvasive assessment of carotid artery plaques and intimamedia thickness and plasma homocysteine measurements may be useful in such patients.

Physical and emotional health effects and social consequences after participation in a low-fat, high-carbohydrate dietary trial for more than 5 years.

PURPOSE: Little is known about the potential adverse effects of interventions to reduce dietary fat. We examined the physical and emotional health effects, and social consequences experienced by women at high risk for breast cancer who had participated in a low-fat diet intervention, randomized, controlled trial for at least 5 years. METHODS: Participants in the Canadian Diet and Breast Cancer Prevention Trial from British Columbia were mailed a survey questionnaire that included the validated Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and Women's Health Questionnaire (WHQ), and a series of questions on health-related and social constructs. Responses were compared between the diet intervention and control groups by menopausal status. RESULTS: Completed questionnaires were returned by 359 women in the diet intervention group and 382 in the control group. No significant differences were found between these groups for SF-36 and WHQ health outcomes, hair/nail changes, physical activity levels, family/friend support levels, and doctor visits. Significantly more women in the intervention group reported taking products for arthritis (other than pain medication), greater difficulty in maintaining eating habits in social situations and at work, greater stress, and guilt related to personal eating habits. These findings persisted for both premenopausal and postmenopausal women. CONCLUSION: Changes resulting from a low-fat diet intervention can be incorporated into women's daily lives with limited long-term negative effects.