RISK-FACTORS IN SCHOOLCHILDREN ASSOCIATED WITH A FAMILY HISTORY OF UNHERALDED MYOCARDIAL-INFARCTION OR UNCOMPLICATED STABLE ANGINA IN MALE RELATIVES

Objectives. The aim of this study was to compare risk factors for coro nary atherosclerosis in children with a family history of unheralded m yocardial infarction or uncomplicated stable angina. Background. In pa tients with unheralded myocardial infarction, coronary atherosclerosis might have a greater tendency to cause acute coronary occlusion than in patients with uncomplicated stable angina, suggesting the possibili ty of different risk factors in these two groups of patients. Methods. Serum lipid levels were compared in children with a family history of unheralded myocardial infarction (236 children) or uncomplicated stab le angina (48 children) or no family history of ischemic heart disease (613 children).Results. Mean (+/- 1 SD) total serum cholesterol was h igher in children with a family history of myocardial infarction than in control subjects (161 +/- 28 vs. 154 +/- 25 mg%, p < 0.01). In chil dren with a family history of stable angina, mean total serum choleste rol (159 +/- 25 mg%) was similar to that in children with family histo ry of myocardial infarction. High density lipoprotein cholesterol and apolipoprotein A-I were higher in children with family history of stab le angina than in children with family history of myocardial infarctio n and control subjects (69 +/- 18 vs. 61 +/- 13 and 60 +/- 13 mg%, p < 0.01; 143 +/- 23 vs. 130 +/- 18 and 129 +/- 18 mg%, p < 0.01, respect ively). In children with a family history of myocardial infarction, th e low density/high density lipoprotein cholesterol ratio was significa ntly higher than in control subjects (1.53 +/- 0.64 vs. 1.44 +/- 0.56, p < 0.05). Conversely, in children with a family history of stable an gina, this ratio (1.24 +/- 0.51) was significantly lower (p < 0.05) th an in control subjects. Conclusions. Risk factors for coronary athersc lerosis in children with a family history of unheralded myocardial inf arction are different from those in children with a family history of uncomplicated stable angina. Higher levels of apolipoprotein A-I early in life might reduce the risk of acute coronary syndromes.