![Some Facts about CHD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Heart Disease and Stroke Statistics — 2009 Update, American Heart Association](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Coronary Heart Disease
Similar to Coronary Heart Disease (20)
More from cphcosu (6)
Recently uploaded
Recently uploaded (20)
Coronary Heart Disease
- 1. Coronary Heart Disease Genetics: An Overview Amy Sturm, MS, CGC Certified Genetic Counselor Clinical Assistant Professor Division of Human Genetics Amy Sturm discloses significant financial interests or other relationships with commercial interests in the following areas: Consultant/Speaker Bureau: Berkeley HeartLab. Presentation will not include discussion of commercial products or services and will not include unapproved or off-label usage of a commercial product or device. The following planning committee members have no significant financial interests or relationships with commercial interests to disclose, their educational unit does not have a financial interest or affiliation with an organization that may receive direct benefit from the subject of the proposed CME activity, and they will not be personally compensated for their role in the planning or execution of this proposed CME activity by an organization other than The Ohio State University: Amy Ehrlich, MA and Henry Zheng, PhD, MBA
- 13. Familial Risk Stratification MI d. 85 MI d. 85 CAD dx. 67 MI dx. 53 MI d. 85 Diabetes dx. 45 Weak Risk Moderate Risk Strong Risk Published Risk Stratification Guidelines in Scheuner MT. Genet Med 2003 CAD dx. 67
- 14. Risk for Early-Onset CHD Given Familial CHD Risk and Number of CVD Risk Factors CVD risk factors = diabetes, hypercholesterolemia, hypertension and obesity Adjusted for age, gender, ethnicity/race, educational level, income, and marital status. Adapted from Table 4, Scheuner MT et al. Genet Med 2006 Familial CHD Risk Three or more n=376 OR a (95% CI) Two n=740 OR a (95% CI) One n=1203 OR a (95% CI) None n=1716 OR a (95% CI) Strong (n=1273) 62.2 (18.5-209.1) 48.6 (14.8-160.0) 17.9 (5.3-61.0) 4.3 (1.1-17.6) Moderate (n=471) 24.9 (5.2-119.7) 27.8 (7.2-106.8) 2.1 (0.21-20.0) 3.6 (0.6-21.9) Weak (n=2291) 16.5 (4.4-61.2) 12.6 (3.6-44.4) 3.7 (1.0-13.9) 1.0 (referent)
- 18. Case Example: Is This Woman at Increased Risk? d. 47 Heart Attack P Breast ca dx 35 40 35 61 d. 6 mo SIDS 10
- 19. Expanding the Pedigree… d. 47 Heart Attack P Breast ca dx 35 40 35 61 d. 6 mo SIDS 10 65 CABGx3, 62 Non-smoker 67 DM dx 55 HTN dx 45 d. 61 Heart attack Now what???
- 20. Familial Risk for Patient: Strong d. 47 Heart Attack P Breast ca dx 35 40 35 61 d. 6 mo SIDS 10 65 CABGx3, 62 Non-smoker 67 DM dx 55 HTN dx 45 d. 61 Heart attack
- 23. Family History as a Guide for Early Detection and Prevention Modified from Scheuner MT. Genet Med 2003 Collect family history every 1-2 years High Moderate Average Possible Mendelian disorder? Assessment of established and emerging CHD risk factors every 1-2 yrs Consider early detection strategies every 2-3 yrs beginning 10 yrs before earliest CHD onset in family Provide personalized prevention strategies tailored to CHD risk factors and presence of subclinical disease Identify at-risk relatives Assessment of established CHD risk factors every 2-3 yrs If multiple risk factors identified, assign high risk Provide personalized prevention strategies tailored to CHD risk factors Assessment of established CHD risk factors every 5 yrs Provide public health prevention messages
Editor's Notes
- Set C1 – Title Slide
- Why is font blue? Are the title fonts supposed to be calibri? Some slides have body font as calibri, some have it as Arial
- Set A1 – Content Slide
- While CHD is not caused by a single gene in most individuals, there are more than 30 single-gene, Mendelian disorders that feature CHD and/or MI. Tests for many of these disorders are available and include DNA-based tests and biochemical analyses. These conditions generally are associated with a substantial risk for coronary disease and heart attack at young ages, and should be included in the differential diagnosis for a family being seen with early onset CHD and MI.
- The familial dyslipidemias are an important subset of conditions that increase risk for premature CHD. Spacing between major bullets might help
- Gap between title and body is too less
- The color of title is different than on previous slides. Again, gap between title and body is too less
- Check title color. Check Bullet font size
- Same comment as prev slides
- Gap between title and body Body font size
- A recent study evaluated the impact on risk of additional family history beyond FDRs with early-onset CHD and found many additional significant associations, shown here as odds ratios, between additional family history characteristics and a personal history of early-onset CHD. This group used data from the national HealthStyles 2003 survey to assess associations between self-reported family history and personal history of early-onset CHD (diagnosed at or before age 60 years). These numbers are adjusted for demographic factors and self-reports of hypercholesterolemia, HTN, and obesity. 4035 respondents, 60% female, 72% white, mean age 48.8 years
- Also, stratification into average (or weak), moderate, and high (or strong)-risk groups is possible, taking into consideration the degree of relatedness of the affected relatives, the ages of diagnosis, and the number of affected relatives. For example, this is a weak risk family with just one 2 nd degree relative affected at a later age, a moderate risk family with two 2 nd degree relatives affected at later ages, and a strong risk family with one 1 st degree relative affected at an early age, as well as two 2 nd degree relatives affected at later ages.
- Also using data from the HealthStyles 2003 Survey, Scheuner et al. have published odds ratios for early-onset CHD given different combinations of level of familial risk, strong, moderate or weak and different numbers of CVD risk factors, which included diabetes, hypercholesterolemia, HTN, and obesity. Weak familial risk plus no other condition was the referent group. Early-onset CHD risk increased exponentially as the number of CVD risk factors and familial risk increased. Strong familial risk plus 3 or more risk factors was associated with a 62.2-fold increase in early-onset CHD risk compared with the referent group.
- In order to assess familial risk for CHD in the clinical setting, personal and family history characteristics of genetic susceptibility to CHD have been determined. These include [Read slide].
- Refer to a local cardiac genetic counselor or when that’s not possible, refer to a local preventative cardiologist. The components of a genetic evaluation for an individual referred because of concern due to a personal or family history of atherosclerosis include [Read slide].
- CHD develops as a result of the interplay between an individual’s environment and their genetic predisposition, therefore any genetic test to predict CHD must include such interactions in the algorithm.
- Set A1 – Content Slide
- Set A1 – Content Slide
- So, our proband has a strong familial risk for CHD.
- Set A1 – Content Slide
- Follow-up with our proband and her family showed that our proband [Read slide].
- Set A1 – Content Slide
- Regarding Michos study: They studied 102 asymptomatic women (mean age 51) who were the sisters of a proband hospitalized with documented premature CHD. 98% were at low risk according to FRE. Based on CAC score percentiles 32% had significant subclinical atherosclerosis and 17% ranked above the 90 th percentile. Sisters of probands with premature CHD appear to be a high-risk group and may warrant non-invasive screening for subclinical disease to appropriately target individuals for more aggressive primary preventive therapy. Other studies have had similar findings.