MARKEDLY HIGH PREVALENCE OF CORONARY RISK-FACTORS IN APPARENTLY HEALTHY AFRICAN-AMERICAN AND WHITE SIBLINGS OF PERSONS WITH PREMATURE CORONARY HEART-DISEASE

Among persons with a family history of premature coronary heart diseas e (CHD), siblings bear an excess risk of CHD that is as high as 12 tim es that of the general population. Aggressive, new, notional guideline s for CHD risk reduction have focused on high-risk families, yet lithe is known about actual remediable risk factors in siblings of persons with premature CHD. To determine the magnitude of the problem relative to the general population, we screened 846 unaffected siblings (ages 30 to 59 years) of persons with documented CHD before age 60 years and compared their risk factor values with population reference norms obt ained in the Third National Health and Nutrition Examination Survey (N HANES III) and the National Health Interview Survey (NHIS). Mean level s of low-density lipoprotein cholesterol were 0.52 mmol/L (20 mg/dl) h igher in siblings; the prevalence of low-density lipoprotein cholester ol greater than or equal to 4.14 mmol/L (160 mg/dl) was nearly twice t hat of race, sex, and age-specific values from NHANES III. Levels of h igh-density lipoprotein cholesterol <0.91 mmol/L (35 mg/dl) were simil ar between siblings and NHANES III (11% and 12%, respectively), Only 4 % of all siblings had triglyceride levels greater than or equal to 4.5 2 mmol/L (400 mg/ dl). Hypertension prevalence was twice as high among siblings as among the NHANES III. Current smoking was 33.9% in white siblings and 25.5% in the NHIS, whereas smoking in African-Americans w as similar to that in the NHIS (31.1% vs 29.2%). A mere 13% to 29% of siblings were without any major remediable risk factors. The overwhelm ing need for risk factor modification in this easily identifiable high -risk population supports aggressive national guidelines and demonstra tes the lack of adequate treatment of apparently healthy siblings of p ersons with premature CHD. (C)1998 by Excerpta Medico, Inc.