None listed
Conditions
Brief summary
Premature cardiovascular disease (CVD) remains a significant cause of morbidity and mortality despite advances in prevention. Patients with myocardial infarction (MI) at a young age represent a unique cohort, with differences in cardiovascular (CV) risk factor profile, underlying pathophysiology, and coronary plaque compared with their older counterparts. In young patients with MI, genetic predisposition contributes to the development of coronary artery disease (CAD). Indeed, family history of premature CVD is a well-recognised risk factor for MI. It is therefore recommended that family members of patients with premature MI undergo CV risk assessment. There are risk scores available for CV risk assessment, such as the Australian CVD risk calculator, which estimates 5-year CVD risk based on clinical factors. Cardiac imaging has shifted the playing field regarding non-invasive detection and assessment of subclinical atherosclerosis. However, cardiac imaging is not currently recommended for large-scale screening in asymptomatic patients but may improve CV risk-stratification and guide use of preventive medications in certain individuals. Families with premature CAD are a high-risk cohort that remain a neglected target for primary prevention. In 300 adult first-degree relatives of individuals with premature MI, this randomised trial will aim to assess whether addition of computed tomography coronary angiography (CTCA) to routine CV risk factor assessment can lead to superior primary prevention low-density lipoprotein cholesterol (LDL-C) levels
Interventions
CT coronary angiography plus routine cardiovascular risk factor assessment.
- CT coronary angiography will be performed at an accredited centre and typically will involve less than 1 hour of the participant's time. An intravenous cannula will be required for iodinated contrast to be administered during the scan.
- The routine cardiovascular risk factor assessment will be performed over 15-30 minutes clinic by a Cardiologist and will involve a clinical assessment of risk factors, medications, ph
CT coronary angiography plus routine cardiovascular risk factor assessment. - CT coronary angiography will be performed at an accredited centre and typically will involve less than 1 hour of the participant's time. An intravenous cannula will be required for iodinated contrast to be administered during the scan. - The routine cardiovascular risk factor assessment will be performed over 15-30 minutes clinic by a Cardiologist and will involve a clinical assessment of risk factors, medications, physical exam findings, blood tests and calculation of risk using the Australian CVD risk calculator.
Sponsors
Curtin University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
30 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
Apparently healthy first-degree relative aged 30 to 55 years of a patient with myocardial infarction at premature age (<55 years).
Exclusion criteria
Exclusion criteria for the apparently healthy relative will include: • History of cardiovascular disease (i.e., coronary artery disease, peripheral arterial disease, or cerebrovascular disease). • Already taking aspirin or statin. • History of iodinated contrast allergy/anaphylaxis. • Known renal impairment with estimated glomerular filtration rate <45 ml/min/1.73m2. • Unwilling or unable to provide informed consent. • Pregnant women. Exclusion criteria for the index case (patient) will include the following diagnoses: • Non-atherosclerotic cause of myocardial infarction such as spontaneous coronary artery dissection, paradoxical venous thrombo-embolism, myocarditis, pericarditis, vasospasm, and Takotsubo cardiomyopathy. • Myocardial infarction with nonobstructive coronary arteries. • Probable or definite familial hypercholesterolaemia by the Dutch Lipid Clinic Network Criteria (score 6 or more). • Age <18 years.
Outcome results
None listed