Early onset Coronary Heart Disease

Posted By  CCF Cardio MD-SGM on November 13, 1997 at 12:06:57:

In Reply to: Early onset Coronary Heart Disease posted by Mark on October 28, 1997 at 16:45:15:

: My 40 year old brother had an MI last week which resulted in stents and angioplasty to open one completely blocked vessel and one 40 - 50% blocked.  Our father had his first MI at 34.  I am 34 and am wondering if I should have any special tests to determine my risk for early onset CAD.  My last cholesterol was in the 190's.  Do you recommend a stress test or would that be premature?

[CCF Cardio MD-SGM]

Dear Mark,
Thanks for the question, and sorry for the delay in getting back to you.  Precocious coronary artery disease is a very serious problem.  The family history you have described is alarming to say the least.  Family history is an important risk factor for coronary artery disease(CAD), as are other risk factors such as male sex, smoking, high blood pressure, elevated cholesterol(especially LDL cholesterol) and higher age.  Given your strong family history, I would strongly advise you to control all the risk factors that you can possibly influence.  For example, stop smoking immediately, and see your doctor to treat any high blood pressure that may exist.  You mention that your cholesterol was in the 190's, and as such it would be unlikely that your LDL cholesterol would be in the range where it would deserve treatment with medications. However, it may be the case that your HDL(good cholesterol) is low.  We like to see HDL in the range above 45.  Things that may increase HDL cholesterol and provide some protection against CAD include exercise, smoking cessation, and (possibly) a glass of red wine on occasion (in moderation).  After addressing the issue of your cholesterol panel, I would recommend the following:
I think it's reasonable to perform an exercise test to look for evidence of ischemia. If this is abnormal, a cardiac catheterization would be recommended.  If  normal, then you'll be reassured but should still follow the lifestyle recommendations I mentioned above.  Finally, after performing a stress test, it would be wise to begin a regular exercise program.
There are special blood tests that screen for certain factors that may contribute to coronary disease that occurs in the absence of the traditional risk factors I have noted.  Such test measure homocysteine, fibrinogen, Lipoprotein "a", for starters.  You probably don't need to perform these tests unless you actually are found to have CAD, however, bringing us back to the issue of a stress test.  
Information provided in the heart forum is intended for information purposes only. Please consult your physician for specific diagnoses and recommendations.