Abstract
Background
Relatives of people with coronary artery disease are at high risk of cardiovascular
(CV) disease, but the effect of focused screening and treatment of this population
is uncertain.
Methods
We searched the Cochrane Library, Medline, and Embase from inception until June 30,
2014 for articles that described screening strategies and primary prevention interventions
targeting family members of patients with coronary artery disease to reduce CV risk.
Results were pooled using a random-effects meta-analysis.
Results
We identified 18 studies that reported screening strategies and 15 reporting interventions
to reduce CV risk. Proband willingness to refer relatives for screening was high (n =
6 studies, pooled rate = 87%; 95% confidence interval [CI], 80%-95%). Studies using
a screening strategy in which the relative was contacted by health care professionals
reported a pooled participation rate of 88% (95% CI, 78%-99%). The quality of interventional
studies was highly variable. Random-effects meta-analysis of the highest quality randomized
studies (n = 6) consisting of a specialized risk factor intervention compared with
usual care was consistent with modest improvements in low-density lipoprotein cholesterol
control (−0.18 mmol/L low-density lipoprotein cholesterol, 95% CI, −0.35 to −0.001;
P = 0.048). Improvements in diet, smoking rates, exercise, and blood pressure were
also observed with active intervention; however, reported outcomes were heterogeneous
precluding a formal meta-analysis.
Conclusions
Screening strategies that target family members, particularly when led by a health
care professional, achieve a high participation rate. Although the available evidence
is of variable quality, interventions that target individuals with a family history
of coronary artery disease appear to be feasible and might be effective in improving
certain risk factors or health behaviours but their long-term CV benefits remain uncertain.
Résumé
Introduction
La famille des personnes souffrant de coronaropathie est exposée à un risque élevé
de maladie cardiovasculaire (CV), mais on ignore les répercussions d’un dépistage
et d’un traitement ciblés chez cette population.
Méthodes
Nous avons examiné les banques de données de la Bibliothèque Cochrane, de Medline
et d’Embase de leur création jusqu’au 30 juin 2014 pour trouver des articles qui décrivaient
les stratégies de dépistage et d’interventions de prévention primaire pour réduire
le risque CV des membres de la famille de patients souffrant de coronaropathie. Nous
avons regroupé les résultats au moyen de la méta-analyse à effets aléatoires.
Résultats
Nous avons trouvé 18 études qui rapportaient des stratégies de dépistage et 15 qui
rapportaient des interventions pour réduire le risque CV. La volonté des proposants
à recommander leur famille pour participer au dépistage était élevée (n = 6 études,
taux pondéré = 87 %; intervalle de confiance [IC] à 95 %, 80 %-95 %). Les études qui
utilisaient une stratégie de dépistage selon laquelle la famille était jointe par
les professionnels de la santé rapportaient un taux pondéré de participation de 88
% (IC à 95 %, 78 %-99 %). La qualité des études interventionnelles était très variable.
La méta-analyse à effets aléatoires d’études aléatoires de qualité supérieure (n =
6) consistant en une intervention spécialisée sur les facteurs de risque et les soins
courants était cohérente avec les modestes améliorations dans la régulation du cholestérol
à lipoprotéines de faible densité (cholestérol à lipoprotéines de faible densité, −0,18
mmol/l, IC à 95 %, −0,35 à −0,001; P = 0,048). Des améliorations du régime alimentaire, des taux de tabagisme, de l’exercice
et de la pression artérielle étaient également observées lors d’interventions actives.
Cependant, les résultats cliniques rapportés étaient hétérogènes et faisaient ainsi
obstacle à une méta-analyse formelle.
Conclusions
La stratégie de dépistage qui cible les membres de la famille, particulièrement lorsqu’elle
est menée par un professionnel de la santé atteint un taux élevé de participation.
Bien que les données probantes disponibles soient de qualité variable, les interventions
qui ciblent les individus ayant des antécédents familiaux de coronaropathie semblent
réalisables et pourraient être efficaces pour améliorer certains facteurs de risque
ou comportements liés à la santé, mais on ignore leurs avantages CV à long terme.
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Article info
Publication history
Published online: February 20, 2015
Accepted:
February 16,
2015
Received:
November 24,
2014
Footnotes
See page 656 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
