Siblings of myocardial infarction patients are overlooked in primary prevention of cardiovascular disease

Aims Patients with arterial hypertension or hypercholesterolaemia may benefit from medical therapy for primary prevention of myocardial infarction. Preventive therapy may be particularly effective in individuals with a positive family history for myocardial infarction since such subjects are at high risk for coronary events. The objective of this population-based study was to analyse the risk profile as well as the current utilization of preventive strategies in asymptomatic siblings of patients with myocardial infarction. Methods and Results We studied siblings of 325 patients with premature myocardial infarction from the Augsburg MONICA myocardial infarction registry by standardized questionnaire, blood pressure recordings, and biochemical measurements. Out of 580 siblings, 510 were free of coronary heart disease symptoms. With multiple risk factors being present in most asymptomatic siblings, 29·4% of asymptomatic individuals had an estimated individual 10-year risk for a major cardiovascular event of ≥20%, or when projected to the age of 60. According to the guidelines of the European Societies of Cardiology, Atherosclerosis, and Hypertension (ESC/EAS/ESH) from 1994 (1998 guidelines in parenthesis) dietary and lifestyle interventions were indicated for arterial hypertension in 48·1% (43·0%) and/or for hypercholesterolaemia in 17·3% (78·8%). Drug treatment was indicated for arterial hypertension in 27·9% (30·6%) and for hypercholesterolaemia in 13·6% (19·1%) of asymptomatic siblings. Of those individuals with the respective indication, actual drug treatment was given for arterial hypertension in 91·5% (83·3%) and for hypercholesterolaemia in 46·4% (33·0%). However, treatment targets were reached in only 31·0% (28·2%) with arterial hypertension and in 7·2% (5·2%) with hypercholesterolaemia, respectively. Conclusions Most asymptomatic individuals with positive fraternal family history have more than one modifiable risk factor. Interestingly, a large number of these individuals appears to be under medical surveillance as many receive some sort of drug treatment. However, this therapy did not meet the treatment goals in the majority of those with arterial hypertension and/or hypercholesterolaemia. Thus, although individuals with a positive fraternal history for myocardial infarction can be easily identified, implementation of sufficient preventive strategies continues to be poor in a Western European country.