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. 1981 Nov 21;283(6303):1358–1360. doi: 10.1136/bmj.283.6303.1358

Contrasting patterns of coronary atherosclerosis in normocholesterolaemic smokers and patients with familial hypercholesterolaemia.

D D Sugrue, G R Thompson, C M Oakley, I M Trayner, R E Steiner
PMCID: PMC1507749  PMID: 6797539

Abstract

An angiographic comparison was made of the extent and severity of coronary artery disease in 25 patients with heterozygous familial hypercholesterolaemia and 25 normocholesterolaemic patients with coronary artery disease in whom heavy cigarette consumption was the chief risk factor. The patients with familial hypercholesterolaemia were younger and included a much higher proportion of women than the smokers. Significantly more patients with familial hypercholesterolaemia had disease of the main stem of the left coronary artery (eight v none, p less than 0.05) and triple-vessel disease (18 v four, p less than 0.05). Disease affecting only distal vessels occurred in five smokers, whereas all the patients with familial hypercholesterolaemia showed a combination of proximal and distal lesions. These findings suggest that cigarette smoking and familial hypercholesterolaemia predispose to different patterns of coronary atheroma. Early coronary angiography with a view to coronary artery bypass surgery seems desirable in symptomatic patients with familial hypercholesterolaemia because of the common association of this disorder with life-threatening left main-stem disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen J. M., Thompson G. R., Myant N. B., Steiner R., Oakley C. M. Cadiovascular complications of homozygous familial hypercholesterolaemia. Br Heart J. 1980 Oct;44(4):361–368. doi: 10.1136/hrt.44.4.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Banks D. C., Raftery E. B., Oram S. Clinical significance of the coronary arteriogram. Br Heart J. 1971 Nov;33(6):863–870. doi: 10.1136/hrt.33.6.863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barboriak J. J., Rimm A. A., Anderson A. J., Tristani F. E., Walker J. A., Flemma R. J. Coronary artery occlusion and blood lipids. Am Heart J. 1974 Jun;87(6):716–721. doi: 10.1016/0002-8703(74)90416-5. [DOI] [PubMed] [Google Scholar]
  4. Beaumont J. L., Carlson L. A., Cooper G. R., Fejfar Z., Fredrickson D. S., Strasser T. Classification of hyperlipidaemias and hyperlipoproteinaemias. Bull World Health Organ. 1970;43(6):891–915. [PMC free article] [PubMed] [Google Scholar]
  5. Beaumont V., Jacotot B., Beaumont J. L. Ischaemic disease in men and women with familial hypercholesterolaemia and xanthomatosis. A comparative study of genetic and environmental factors in 274 heterozygous cases. Atherosclerosis. 1976 Sep;24(3):441–450. doi: 10.1016/0021-9150(76)90136-2. [DOI] [PubMed] [Google Scholar]
  6. Bloch A., Dinsmore R. E., Lees R. S. Coronary arteriographic findings in type-II and type-IV hyperlipoproteinaemia. Lancet. 1976 May 1;1(7966):928–930. doi: 10.1016/s0140-6736(76)92711-2. [DOI] [PubMed] [Google Scholar]
  7. Carvalho A. C., Colman R. W., Lees R. S. Platelet function in hyperlipoproteinemia. N Engl J Med. 1974 Feb 21;290(8):434–438. doi: 10.1056/NEJM197402212900805. [DOI] [PubMed] [Google Scholar]
  8. Carvalho A. C., Lees R. S. Platelets intravascular coagulation and fibrinolysis in hyperlipidaemias: relationship to thrombo-embolic complications. Acta Med Scand Suppl. 1980;642:101–112. doi: 10.1111/j.0954-6820.1980.tb10941.x. [DOI] [PubMed] [Google Scholar]
  9. Crittin J., Waters D. D., Théroux P., Mizgala H. F. Left main coronary artery stenosis in young patients. Chest. 1979 Nov;76(5):508–513. doi: 10.1378/chest.76.5.508. [DOI] [PubMed] [Google Scholar]
  10. DOYLE J. T., DAWBER T. R., KANNEL W. B., HESLIN A. S., KAHN H. A. Cigarette smoking and coronary heart disease. Combined experience of the Albany and Framingham studies. N Engl J Med. 1962 Apr 19;266:796–801. doi: 10.1056/nejm196204192661602. [DOI] [PubMed] [Google Scholar]
  11. Falsetti H. L., Schnatz J. D., Greene D. G., Bunnell I. L. Lipid and carbohydrate studies in coronary artery disease. Circulation. 1968 Feb;37(2):184–191. doi: 10.1161/01.cir.37.2.184. [DOI] [PubMed] [Google Scholar]
  12. Garrison R. J., Kannel W. B., Feinleib M., Castelli W. P., McNamara P. M., Padgett S. J. Cigarette smoking and HDL cholesterol: the Framingham offspring study. Atherosclerosis. 1978 May;30(1):17–25. doi: 10.1016/0021-9150(78)90149-1. [DOI] [PubMed] [Google Scholar]
  13. Gordon T., Kannel W. B. Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. JAMA. 1972 Aug 14;221(7):661–666. [PubMed] [Google Scholar]
  14. Gotto A. M., Gorry G. A., Thompson J. R., Cole J. S., Trost R., Yeshurun D., DeBakey M. E. Relationship between plasma lipid concentrations and coronary artery disease in 496 patients. Circulation. 1977 Nov;56(5):875–883. doi: 10.1161/01.cir.56.5.875. [DOI] [PubMed] [Google Scholar]
  15. Hawkins R. I. Smoking, platelets and thrombosis. Nature. 1972 Apr 28;236(5348):450–452. doi: 10.1038/236450a0. [DOI] [PubMed] [Google Scholar]
  16. Heiberg A. The risk of atherosclerotic vascular disease in subjects with xanthomatosis. Acta Med Scand. 1975 Oct;198(4):249–261. doi: 10.1111/j.0954-6820.1975.tb19536.x. [DOI] [PubMed] [Google Scholar]
  17. Heinle R. A., Levy R. I., Frederickson D. S., Gorlin R. Lipid and carbohydrate abnormalities in patients with angiographically documented coronary artery disease. Am J Cardiol. 1969 Aug;24(2):178–186. doi: 10.1016/0002-9149(69)90401-9. [DOI] [PubMed] [Google Scholar]
  18. Judkins M. P. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967 Nov;89(5):815–824. doi: 10.1148/89.5.815. [DOI] [PubMed] [Google Scholar]
  19. Lim J. S., Proudfit W. L., Sones F. M., Jr Left main coronary arterial obstruction: Long-term follow-up of 141 nonsurgical cases. Am J Cardiol. 1975 Aug;36(2):131–135. doi: 10.1016/0002-9149(75)90515-9. [DOI] [PubMed] [Google Scholar]
  20. MUSTARD J. F., MURPHY E. A. Effect of smoking on blood coagulation and platelet survival in man. Br Med J. 1963 Mar 30;1(5334):846–849. doi: 10.1136/bmj.1.5334.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mabuchi H., Ito S., Haba T., Ueda K., Ueda R. Discrimination of familial hypercholesterolemia and secondary hypercholesterolemia by Achilles' tendon thickness. Atherosclerosis. 1977 Sep;28(1):61–68. doi: 10.1016/0021-9150(77)90199-x. [DOI] [PubMed] [Google Scholar]
  22. Meade T. W., Chakrabarti R., Haines A. P., North W. R., Stirling Y. Characteristics affecting fibrinolytic activity and plasma fibrinogen concentrations. Br Med J. 1979 Jan 20;1(6157):153–156. doi: 10.1136/bmj.1.6157.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Mjos O. D., Thelle D. S., Forde O. H., Vik-Mo H. Family study of high density lipoprotein cholesterol and the relation to age and sex. The Tromso Heart Study. Acta Med Scand. 1977;201(4):323–329. doi: 10.1111/j.0954-6820.1977.tb15707.x. [DOI] [PubMed] [Google Scholar]
  24. Murray R. G., Tweddel A., Third J. L., Hutton I., Hillis W. S., Lorimer A. R., Lawrie T. D. Relation between extent of coronary artery disease and severity of hyperlipoproteinaemia. Br Heart J. 1975 Dec;37(12):1205–1209. doi: 10.1136/hrt.37.12.1205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Nitter-Hauge S., Enge I. Relation between blood lipid levels and angiographically evaluated obstructions in coronary arteries. Br Heart J. 1973 Aug;35(8):791–795. doi: 10.1136/hrt.35.8.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nordoy A., Rodset J. M. Platelet function and platelet phospholipids in patients with hyperbetalipoproteinemia. Effect of nicotinic acid and clofibrate. Acta Med Scand. 1971 May;189(5):385–389. [PubMed] [Google Scholar]
  28. Reid D. D., Hamilton P. J., McCartney P., Rose G., Jarrett R. J., Keen H. Smoking and other risk factors for coronary heart-disease in British civil servants. Lancet. 1976 Nov 6;2(7993):979–984. doi: 10.1016/s0140-6736(76)90830-8. [DOI] [PubMed] [Google Scholar]
  29. Roberts W. C. The status of the coronary arteries in fatal ischemic heart disease. Cardiovasc Clin. 1975;7(2):1–24. [PubMed] [Google Scholar]
  30. Slack J. Risks of ischaemic heart-disease in familial hyperlipoproteinaemic states. Lancet. 1969 Dec 27;2(7635):1380–1382. doi: 10.1016/s0140-6736(69)90930-1. [DOI] [PubMed] [Google Scholar]
  31. Stone N. J., Levy R. I., Fredrickson D. S., Verter J. Coronary artery disease in 116 kindred with familial type II hyperlipoproteinemia. Circulation. 1974 Mar;49(3):476–488. doi: 10.1161/01.cir.49.3.476. [DOI] [PubMed] [Google Scholar]
  32. Trayner I. M., Mannarino E., Clyne C. A., Thompson G. R. Serum lipids and high density lipoprotein cholesterol in peripheral vascular disease. Br J Surg. 1980 Jul;67(7):497–499. doi: 10.1002/bjs.1800670715. [DOI] [PubMed] [Google Scholar]
  33. Williams P., Robinson D., Bailey A. High-density lipoprotein and coronary risk factors in normal men. Lancet. 1979 Jan;1(8107):72–75. doi: 10.1016/s0140-6736(79)90063-1. [DOI] [PubMed] [Google Scholar]
  34. Záhor Z., Czabanová V. Experimental atherosclerosis of the heart valves in rats following a long-term atherogenic regimen. Atherosclerosis. 1977 May;27(1):49–57. doi: 10.1016/0021-9150(77)90023-5. [DOI] [PubMed] [Google Scholar]

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