Objectives. The aim of this study was to compare risk factors for coronary atherosclerosis in children with a family history of unheralded myocardial infarction or uncomplicated stable angina. Background. In patients with unheralded myocardial infarction, coronary atherosclerosis might have a greater tendency to cause acute coronary occlusion than in patients with uncomplicated stable angina, suggesting the possibility of different risk factors in these two groups of patients. Methods. Serum lipid levels were compared in children with a family history of unheralded myocardial infarction (236 children) or uncomplicated stable angina (48 children) or no family history of ischemic heart disease (613 children). Results. Mean (± 1 SD) total serum cholesterol was higher in children with a family history of myocardial infarction than in control subjects (161 ± 28 vs. 154 ± 25 mg%, p <0.01). In children with a family history of stable angina, mean total serum cholesterol (159 ± 25 mg%) was similar to that in children with family history of myocardial infarction. High density lipoprotein cholesterol and apolipoprotein A-I were higher in children with family history of stable angina than in children with family history of myocardial infarction and control subjects (69 ± 18 vs. 61 ± 13 and 60 ± 13 mg%, p <0.01; 143 ± 23 vs. 130 ± 18 and 129 ± 18 mg%, p <0.01, respectively). in children with a family history of myocardial infarction, the low density/high density lipoprotein cholesterol ratio was significantly higher than in control subjects (1.53 ± 0.64 vs. 1.44 ± 0.56, p <0.05). Conversely, in children with a family history of stable angina, this ratio (1.24 ± 0.51) was significantly lower (p <0.05) than in control subjects. Conclusions. Risk factors for coronary athersclerosis in children with a family history of unheralded myocardial infraction are different from those in children with a family history of uncomplicated stable angina. Higher levels of apolipoprotein A-I early in life might reduce the risk of acute coronary syndromes.
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