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Canadian Journal of Cardiology

Screening Strategies and Primary Prevention Interventions in Relatives of People With Coronary Artery Disease: A Systematic Review and Meta-analysis

  • Michael Goldfarb
    Affiliations
    Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada
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  • Douglas Slobod
    Affiliations
    Department of Medicine, Division of Internal Medicine, McGill University Health Centre, Montreal, Québec, Canada
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  • Line Dufresne
    Affiliations
    Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada
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  • James M. Brophy
    Affiliations
    Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada
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  • Allan Sniderman
    Affiliations
    Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada
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  • George Thanassoulis
    Correspondence
    Corresponding author: Dr George Thanassoulis, Preventive and Genomic Cardiology, Divisions of Cardiology and Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave West, Montreal, Québec H3A 1A1, Canada. Tel.: +1-514-934-1934 ×35465.
    Affiliations
    Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, Québec, Canada

    The Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Québec, Canada
    Search for articles by this author
Published:February 20, 2015DOI:https://doi.org/10.1016/j.cjca.2015.02.019

      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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      References

        • Lloyd-Jones D.M.
        • Nam B.H.
        • D’Agostino R.B.
        • et al.
        Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring.
        JAMA. 2004; 291: 2204-2211
        • Murabito J.M.
        • Pencina M.J.
        • Nam B.H.
        • et al.
        Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults.
        JAMA. 2005; 294: 3117-3123
        • Lawson K.D.
        • Fenwick E.A.
        • Pell A.C.
        • Pell J.P.
        Comparison of mass and targeted screening strategies for cardiovascular risk: simulation of the effectiveness, cost-effectiveness and coverage using a cross-sectional survey of 3921 people.
        Heart. 2010; 96: 208-212
        • Anderson T.J.
        • Gregoire J.
        • Hegele R.A.
        • et al.
        2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.
        Can J Cardiol. 2013; 29: 151-167
        • Goff Jr., D.C.
        • Lloyd-Jones D.M.
        • Bennett G.
        • et al.
        2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S49-73
        • Perk J.
        • De Backer G.
        • Gohlke H.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).
        Eur Heart J. 2012; 33: 1635-1701
        • Chow C.K.
        • Pell A.C.
        • Walker A.
        • et al.
        Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention.
        BMJ. 2007; 335: 481-485
        • Ton T.G.
        • Fogg T.T.
        • Fong C.T.
        • et al.
        Knowledge, perception, and behaviors of relatives of people with premature heart disease: a systematic literature review.
        Circulation. 2011; 124: 958-964
        • Higgins P.T.
        • Green S.
        Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. The Cochrane Collaboration.
        Cochrane Database Syst Rev. 2011; (Available at: http://www.cochrane-handbook.org. Accessed March 12, 2013)
        • Becker D.M.
        • Raqueno J.V.
        • Yook R.M.
        • et al.
        Nurse-mediated cholesterol management compared with enhanced primary care in siblings of individuals with premature coronary disease.
        Arch Intern Med. 1998; 158: 1533-1539
        • Becker D.M.
        • Yanek L.R.
        • Johnson Jr., W.R.
        • et al.
        Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease.
        Circulation. 2005; 111: 1298-1304
        • Mosca L.
        • Mochari H.
        • Liao M.
        • et al.
        A novel family-based intervention trial to improve heart health: FIT Heart: results of a randomized controlled trial.
        Circ Cardiovasc Qual Outcomes. 2008; 1: 98-106
        • Moy T.F.
        • Yanek L.R.
        • Raqueno J.V.
        • et al.
        Dietary counseling for high blood cholesterol in families at risk of coronary disease.
        Prev Cardiol. 2001; 4: 158-164
        • Reid R.D.
        • McDonnell L.A.
        • Riley D.L.
        • et al.
        Effect of an intervention to improve the cardiovascular health of family members of patients with coronary artery disease: a randomized trial.
        CMAJ. 2014; 186: 23-30
        • Tonstad S.
        • Sundfor T.
        • Seljeflot I.
        Effect of lifestyle changes on atherogenic lipids and endothelial cell adhesion molecules in young adults with familial premature coronary heart disease.
        Am J Cardiol. 2005; 95: 1187-1191
        • Wood D.A.
        • Kotseva K.
        • Connolly S.
        • et al.
        Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial.
        Lancet. 2008; 371: 1999-2012
        • Wrigley M.J.
        • Pakrashi T.
        • Maslin-Prothero S.
        • Watkinson G.
        Primary Prevention for Coronary Heart Disease: past evidence, present measures and future challenges.
        Br J Card Nurs. 2006; 1: 294-304
        • Kral B.G.
        • Becker L.C.
        • Vaidya D.
        • Yanek L.R.
        • Becker D.M.
        Silent myocardial ischaemia and long-term coronary artery disease outcomes in apparently healthy people from families with early-onset ischaemic heart disease.
        Eur Heart J. 2011; 32: 2766-2772
        • Tonstad S.
        • Westheim A.
        Implementation of guidelines to screen relatives of patients with premature coronary heart disease in a hospital setting.
        Am J Cardiol. 2002; 90: 1211-1214
        • Walker R.
        • Heller R.
        • Redman S.
        • O’Connell D.
        • Boulton J.
        Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients.
        Prev Med. 1992; 21: 616-629
        • Goble A.
        • Jackson B.
        • Phillips P.
        • et al.
        The Family Atherosclerosis Risk Intervention Study (FARIS): risk factor profiles of patients and their relatives following an acute cardiac event.
        Aust N Z J Med. 1997; 27: 568-577
        • Heller R.F.
        • Walker R.J.
        • Boyle C.A.
        • et al.
        A randomised controlled trial of a dietary advice program for relatives of heart attack victims.
        Med J Aust. 1994; 161: 529-531
        • Kavanagh T.
        • Shephard R.J.
        • Hamm L.F.
        • Mertens D.J.
        • Thacker L.
        Risk profile and health awareness in male offspring of parents with premature coronary heart disease.
        J Cardiopulm Rehabil. 2000; 20: 172-179
        • Thompson H.J.
        • Pell A.C.
        • Anderson J.
        • Chow C.K.
        • Pell J.P.
        Screening families of patients with premature coronary heart disease to identify avoidable cardiovascular risk: a cross-sectional study of family members and a general population comparison group.
        BMC Res Notes. 2010; 3: 132
        • Qureshi N.
        • Armstrong S.
        • Dhiman P.
        • et al.
        Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care: a matched-pair, cluster randomized trial.
        Ann Intern Med. 2012; 156: 253-262
        • McCance K.L.
        • Eutropius L.
        • Jacobs M.K.
        • Williams R.R.
        Preventing coronary heart disease in high-risk families.
        Res Nurs Health. 1985; 8: 413-420
        • Knutsen S.F.
        • Knutsen R.
        The Tromso Survey: the Family Intervention study–the effect of intervention on some coronary risk factors and dietary habits, a 6-year follow-up.
        Prev Med. 1991; 20: 197-212
        • McCann T.J.
        • Criqui M.H.
        • Kashani I.A.
        • et al.
        A randomized trial of cardiovascular risk factor reduction: patterns of attrition after randomization and during follow-up..
        J Cardiovasc Risk. 1997; 4: 41-46
        • Mendes G.
        Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease.
        Arq Bras Cardiol. 2006; 86: 361-365
        • Aggarwal B.
        • Liao M.
        • Mosca L.
        Predictors of physical activity at 1 year in a randomized controlled trial of family members of patients with cardiovascular disease..
        J Cardiovasc Nurs. 2010; 25: 444-449
        • Ebrahim S.
        • Taylor F.
        • Ward K.
        • et al.
        Multiple risk factor interventions for primary prevention of coronary heart disease.
        Cochrane Database Syst Rev. 2011; : CD001561https://doi.org/10.1002/14651858.CD001561.pub3
        • Lin J.S.
        • O’Connor E.
        • Evans C.V.
        • et al.
        Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: a systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2014; 161: 568-578
        • Hallowell N.
        • Jenkins N.
        • Douglas M.
        • et al.
        Patients’ experiences and views of cascade screening for familial hypercholesterolemia (FH): a qualitative study.
        J Community Genet. 2011; 2: 249-257
        • Karwalajtys T.
        • Kaczorowski J.
        • Chambers L.W.
        • et al.
        A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients [ISRCTN61739603].
        BMC Fam Pract. 2005; 6: 35
        • Nystuen P.
        • Hagen K.B.
        Telephone reminders are effective in recruiting nonresponding patients to randomized controlled trials.
        J Clin Epidemiol. 2004; 57: 773-776
        • Beaton S.J.
        • Sperl-Hillen J.M.
        • Worley A.V.
        • et al.
        A comparative analysis of recruitment methods used in a randomized trial of diabetes education interventions.
        Contemp Clin Trials. 2010; 31: 549-557
        • Mochari-Greenberger H.
        • Terry M.B.
        • Mosca L.
        Does stage of change modify the effectiveness of an educational intervention to improve diet among family members of hospitalized cardiovascular disease patients?.
        J Am Diet Assoc. 2010; 110: 1027-1035
        • Williams R.R.
        • Hunt S.C.
        • Heiss G.
        • et al.
        Usefulness of cardiovascular family history data for population-based preventive medicine and medical research (the Health Family Tree Study and the NHLBI Family Heart Study).
        Am J Cardiol. 2001; 87: 129-135
      1. Department of Health. Putting Prevention First. Vascular checks risk assessment and management - impact assessment. Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083822. Accessed April 1, 2013.

        • Schuetz C.A.
        • Alperin P.
        • Guda S.
        • et al.
        A standardized vascular disease health check in Europe: a cost-effectiveness analysis.
        PLoS One. 2013; 8: e66454
        • Otaki Y.
        • Gransar H.
        • Berman D.S.
        • et al.
        Impact of family history of coronary artery disease in young individuals (from the CONFIRM registry).
        Am J Cardiol. 2013; 111: 1081-1086
        • Jackson P.R.
        The influence of absolute cardiovascular risk, patient utilities and costs on the decision to treat hypertension: a Markov decision analysis.
        J Hypertens. 2003; 21: 1631-1634