Circulation, Vol 67, 943-954, Copyright © 1983 by American Heart Association
HN Neufeld and U Goldbourt
Morbidity and mortality differences between populations, between ethnic
groups and between individuals are not satisfactorily explained by the
variation of risk factors. Differences in genetic susceptibility might be
responsible for a part of the unexplained variation of coronary heart
disease (CHD) rates. Genetic factors are also significant in determining
the level of risk factors in individuals. Ample evidence links genetic
factors to the levels of serum cholesterol, blood pressure and diabetes.
Marked sex differences in CHD mortality also indicate the role of heredity
in the development of the disease. The male:female ratio varies widely
between different countries, as well as between different ethnic groups.
These variations are difficult to explain by variation in environmental and
behavioral differences between males and females alone. The degree of
atherosclerosis in males and females varies, depending on the anatomic
location of the atherosclerosis. Inherited disorders of metabolism and the
variability of anatomic patterns provide additional indications of the role
of genetics. The data accumulated in the Israeli Ischemic Heart Disease
Study over 15 years reveal an ethnic variation of risk factors coupled with
remarkably larger variation in disease rates. Patterns of incidence
assessed in the national mortality data of the Israeli study and in
histologic findings in the coronary arteries of infants from different
ethnic groups are compatible with a hypothesis that ethnic and sex
differences in early structural changes of the coronary arteries partly
determine the susceptibility of the latter to the development of
atherosclerosis. In conclusion, findings from our studies and the review of
the evidence from genetic epidemiologic investigations indicate a
significant role of genetics in determining the degree, time course and
severity of the atherosclerotic process and of the occurrence of
symptomatic CHD. This important role of the genetic component is relevant
to preventive strategies offered as tools for reducing the burden of CHD.
Research into genetic determinants of both susceptibility to
atherosclerosis or clinical manifestation of CHD and individual response to
preventive measures should be encouraged.
ARTICLES
Coronary heart disease: genetic aspects
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