Approach to patients with a family history of premature ASCVD
From the creator of the fan favorite CardioNerds Right Heart Catheterization infographic, (Dr. Ahmed Ghoneem) comes this comprehensive Family History of Premature ASCVD Infographic. Recognizing and counseling patients with a family history of premature ASCVD is an important, and sometimes challenging, aspect of cardiovascular prevention. This infographic is meant to address the concerns of our patients and guide shared decision making in that setting.
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Family History of Premature ASCVD by Dr. Ahmed Ghoneem
References:
Definitions and PCE
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.03.010?_ga=2.258727882.1998796163.1640223787-1596507143.1634435988
Data that shows in individuals at high genetic risk, a healthy lifestyle (e.g., no smoking, regular exercise, healthy diet, weight management) reduces risk of CAD by up to 50%.
- Khera AV, Emdin CA, Drake I, et al. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. New England Journal of Medicine. 2016;375(24):2349-2358. https://www.nejm.org/doi/10.1056/NEJMoa1605086?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov
AHA Life’s simple 7
Patients with intermediate risk and “Risk Enhancing Factors”, in your case a family history of premature ASCVD, benefit from statins.
- Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the Primary Prevention of Cardiovascular Events in Women With Elevated High-Sensitivity C-Reactive Protein or Dyslipidemia. Circulation. 2010;121(9):1069-1077. https://www.ahajournals.org/doi/10.1161/circulationaha.109.906479
CAC in patients with a family history of premature ASCVD
- Nasir K, Budoff MJ, Wong ND, et al. Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2007;116(6):619-626. https://pubmed.ncbi.nlm.nih.gov/17646582/
- Cohen R, Budoff M, McClelland RL, et al. Significance of a Positive Family History for Coronary Heart Disease in Patients With a Zero Coronary Artery Calcium Score (from the Multi-Ethnic Study of Atherosclerosis). The American Journal of Cardiology. 2014;114(8):1210-1214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177938/
Lipoprotein (a) and family history of premature ASCVD
- Willeit P, Kiechl S, Kronenberg F, et al. Discrimination and net reclassification of cardiovascular risk with lipoprotein(a): prospective 15-year outcomes in the Bruneck Study. Journal of the American College of Cardiology. 2014;64(9):851-860. https://pubmed.ncbi.nlm.nih.gov/25169167/
- Mehta A, Virani SS, Ayers CR, et al. Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk. Journal of the American College of Cardiology. 2020;76(7):781-793. https://pubmed.ncbi.nlm.nih.gov/32792075/
About the infographic Creator
Dr. Ahmed Ghoneem is an internal medicine resident at Lahey Hospital and Medical Center in Burlington, Massachusetts. He received his medical degree from Alexandria University in Egypt, where he also completed a 4-year cardiology residency and one year as a junior faculty member. In 2018, he joined the Cardiovascular Imaging Research Center at the Massachusetts General Hospital in Boston as a clinical research fellow up until he started his residency last July. His interests include cardiac PET imaging, mechanical circulatory support and interventional cardiology, with a special passion for structural interventions. Outside the hospital, he is quite the movie buff ; a huge fan of Quentin Tarantino and “everything Batman”.
Acknowledgements
Ann Marie Navar, MD, PhD, Associate Professor at UT Southwestern Medical Center. See CardioNerds episode 42. Lipid Management with Drs. Ann Marie Navar & Nishant Shah.
